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Above the Fold

When is a Medical Error a Crime? by Bob Wachter

Nov 16, 2007• 17

Bob Wachter is one of the nation’s leading experts on medical safety and one of the pioneers of the hospitalist movement. And now he’s descending into the mire of blogging! So we’re pleased to cross post one of the more recent pieces from his (relatively) new blog Wachter’s World.

Robert_wachter The first commandment of the modern patient safety movement was “Thou Shalt Not Blame.”
Old-Think:
errors are screw-ups by “bad apples,” and can only be prevented by some
combination of shaming and suing the doctor or nurse holding the
smoking gun. New-Think: errors represent “system problems;” any
attempt to assess blame will drive providers underground, inhibiting
the free-flow of information so crucial to error prevention. Like
most complicated issues in life, the truth lives somewhere between
these polar views. In the main, the “no blame” view is right – most
errors are committed by good, hardworking docs and nurses, and
finger-pointing simply distracts us from the systems fixes that can
prevent the next fallible human being from killing someone.Yet,
taken to extremes, the no blame argument has always struck me as both
naive and more than a little PC. Anyone who has practiced for more than
a month can name docs and nurses who they would never want caring for
their loved ones. And what about the substance-abusing nurse, the
internist who doesn’t keep up with the literature, the
retractor-throwing surgeon, or the provider who refuses to follow
reasonable safety rules. If nobody is ever to blame, who is
accountable?

Think Again: Payments to doctors By Eric Novack

Nov 16, 2007• 9

I am frankly a bit surprised at the lack of comment at THCB on the recent orthopedic device
manufacturers’ settlement with the government for concerns about illegal payments to physicians. I would have expected Matthew or Maggie, at least, to be sounding the alarm over the dangers of the private sector in healthcare. The most interesting byproduct of the settlement is the development of a public database where you can search by company to see who is getting the ‘big bucks’.

But like many simple statistics, the data can be misleading.

Let me be clear—paying a surgeon for ‘work’ with the real expectation that he or she will use a specific product is unethical, not to mention illegal (but a problem inherent in our 3rd party paymentsystem in medicine, but that is another issue entirely…).

One Phoenix area surgeon has been paid $3 million this year by Stryker.

‘Outrageous’, you say. “Ah- ha—see, all doctors are corrupt and need to be controlled”, others exclaim. But what are the facts? In this case, the surgeon helped develop some of the early hip and knee replacement designs… These designs have served as the basis for literally millions of replaced joints over the last 20 years. He owns a piece of the patent.Is it immoral to get paid for people using a product you work hard to develop? Should Google’s founders still benefit? How about those who own patents on everything vacuum cleaners to hair care products?

Of course they should– because our society encourages innovation by protecting the value of innovation.

TECH: Yes there are other conferences…

Nov 16, 2007• 2

Apparently Health IT is feeling left out and needs a CEO forum-type conference. The people at CCS are trying to create it at a flash hotel in Bel-Air no less. For a pretty humorous run down take a look at the The HIT Transition Weblog’s write up.

Health 2.0 at the CCR Workshop in San Diego and thoughts about Google’s Subauth, by Indu Subaiya

Nov 15, 2007

Indu Yesterday we attended David Kibbe’s CCR workshop in San Diego and learned lots about XML and the
utility of the continuity of care record in many different settings. For more info about the CCR, read David’s posts on the topic – here and here.

Over the course of the workshop, there were presentations by Rick Peters, the chief architect of the
CCR who has recently left a PBM start-up to look at several new
opportunities, Steve Waldren of the AAFP, Michael Rosenthal from Minute Clinic and Google’s
Jerry Lin. In the audience were people from Microsoft (Healthvault),
Qualcomm, Rediclinic, Patients Like Me, Edmund Billings from OpenHealth
and Michael Mee, who is working with Adam Bosworth on his new gig, and
a host of tech companies and provider groups offering or trying to
implement the CCR functionality respectively.

Google’s Jerry Lin sparked a heated debate about security and
authentication and whether username and password based systems were
enough or whether you needed 2 factor or 3 factor authentication.
Google’s subauth was pretty cool I thought although the open source
version known as oauth is more likely to be relevant to apps outside of
Google.Continue reading this post over at the Health 2.0 Blog

What the Blogs are saying …

Nov 15, 2007

Adam Bosworth, describing life post-Google:

"Well, as some seem to know, I’ve left Google. And now that I’ve
left, that old entrepreneurial fever has struck me again and I’m off
working on a startup. Google is a wonderful company and I had a great
time there and had a lot of fun building something I really believe in,
Google Health, which I think has a great potential to change the way
consumers manage their health when it launches. Still, for me, it is
time to start a new company and I’m off and running.

I’ve been dusting off extremely rusty engineering habits and writing
code. Not elegant code to be frank. Just enough to think through my
ideas. Some extremely clear-headed and smart people can work out
everything abstractly in their heads and then just go and implement it.
I’m not one of them. Watching me write code is like watching an
indecisive sculptor work with clay. I shape it. I look. I wince. I
reshape it. I play with it. I wince some more. I ask my friends, nurse
my wounds, and then reshape it yet again. And so on. Constant iterative
development. It takes three tries before it is even close to the way it
should be, best case. I think it is totally worth it. The arguments and
design decisions are just way more concrete and tested."

Continuez

The Download squad on the impending PHR Wars

"This raises an interesting question. Are doctors going to want to sign
up for Microsoft, Google, ZocDoc, and other online services just to
communicate with their patients? It seems more likely that an
individual doctor or medical practice will pick one service and then
stick with it.

For example, if you take your kid to Fluffy
Bunny pediatrics, you’ll find that the doctors are willing to share all
of your child’s medical records with you over Microsoft HealthVault. If
you sign up for Google Health, you’ll have to get old-fashioned paper
records. Because otherwise, Fluffy Bunny doctors would have to spend
time submitting all of their documents to 2 or more different sites,
which would increase their workload, not decrease it. This, of course
would force health consumers to sign up for multiple services if they
want to make sure they have access to the latest information from all
of their doctors, meaning that you’re the one with a disorganized mess,
not your doctor."

BLOGS: Health Beat Hosts Health Wonk Review

Nov 15, 2007

Prolific author and THCB favorite Maggie Mahar is doing the honors this week as Health Beat Hosts Health Wonk Review.

POLICY: Taking Out The Trash-Talk

Nov 15, 2007• 10

I’m up at Spot-on talking about a particularly crappy study that snuck into a WSJ editorial. I made some snarky remarks about the math skills of economists at the Manhattan Institute in the process. Of course after the editing process a Spot-on it all got a little smoother, shall we say

I’m not too worried that a Republican will actually win the White House in 2008. But I am worried that efforts by what I confidently believe will be a Democratically controlled White House to reform the U.S. health care system will founder on the free-marketeers devotion to faulty statistics, unsound analysis and, well, lying.It’s not a new problem. But it’s one that’s increasingly difficult to combat.

Read the rest and of course come back here to comment if you like.

Health 2.0 Research & Editorial Internship

Nov 14, 2007

Become a part of the Health 2.0 revolution! The Health 2.0 Conference team is looking
for a few smart, motivated students to fill unpaid Health 2.0 internships. The interns will work with co-founders Matthew Holt and Indu Subaiya on all aspects of the business including the Health 2.0 conference, Internet media properties including ‘The Health Care Blog’ and a Health 2.0 blog, research, and consulting.

Responsibilities will include a wide range of research, editorial, writing, marketing, and event support tasks. The ideal candidates have an interest in healthcare, business, and technology, are detail oriented, Web and media savvy, with excellent writing skills.

JOB POST: Director, US Sales

Nov 14, 2007• 1

Wellness Layers Inc. has an immediate
opening for a Director of Sales to lead our US Sales. Wellness Layers helps the world’s leading
fitness, nutrition, health and pharmaceutical companies create private
label customer portals, which are tightly integrated with their services
and products.

The ideal candidate should be based locally within
the NY/NJ area and work from his/her home office and our New York office.
This is a role for a strong leader with a history of building and
leading successful enterprise software sales teams. You must be an
individual with an entrepreneurial spirit, extremely intelligent,
dedicated, and tough enough to work in a dynamic, fast-paced environment.

Your responsibility would be to focus on creating opportunities
and selling our unique Web 2.0 Platform product and services to large and
medium customers, focusing on the Wellness, Nutrition, Fitness, Pharma and
Health industries. Target contacts are VP Marketing and Brand Managers.

A Patient in my own hospital by Paul Levy

Nov 14, 2007

Paul Levy is CEO at Beth-Israel Deaconess Medical Center in Boston. Paul was one of the first CEOs to embrace blogging and continues to use his popular online column as a forum to express his views on the business of healthcare, public policy in Massachusetts and the challenges of being a manager in a very challenging field. In this latest post he addresses a problem you wouldn’t think would be problem for a top manager at a facility affiliated with Harvard Medical School: The very real risk to his health his job poses. He blogs at Running a Hospital.

Two stories about being a patient in my own hospital.

(1)
I am really lucky to have a primary care doctor who knows how to
protect me, as president of our hospital, from our well meaning
doctors. Why do I need protection? Well, because the specialists are
really proud of their work and want to use any malady that I have to
show me their stuff. My doctor knows how dangerous this can be!

A
few years ago, I signed up for an ocean kayaking trip in Patagonia.
This was to entail pretty strenuous outdoor living and paddling all day
long for two weeks. The program therefore required a physical exam and
recommended a stress test for those over a "certain age." So I asked my
PCP to order one.

She says, "No. I refuse to order a stress test for you."

"Huh?", I reply intelligently.

"Here’s
the deal," she says. "If I order the stress test, our especially
attentive (knowing who you are) cardiologist will note some odd
peculiarity about your heartbeat. He will then feel the need, because
you are president of the hospital, to do a diagnostic catheterization.
Then, there will be some kind of complication during the
catheterization, and you will end up being harmed by the experience."