Archive for April, 2015

Anti-Vaccination Madness

Friday, April 10th, 2015

Once any idea becomes accepted by the general public, it becomes frozen by habit and time; when it’s proven wrong the “falsehood index” hardly declines. New evidence is ignored in the zeitgeist of immutable belief. I am indebted to the comedian, Stephen Colbert, for introducing us to his term, truthiness-in the dictionary now-signifying imitation or ersatz truth, the appeal of raw feeling over proven reality.

Tragically, truthiness can get dangerous. Vaccine-preventable diseases, such as diphtheria, pertussis, tetanus, measles, mumps, and rubella are increasing.  The anti-vaccination hysteria which has resulted in measles (as well pertussis) coming back to haunt us after years of virtual disappearance.   By 2000 measles was virtually eliminated in this country.  But worldwide, there are still about 20 million cases a year; in 2013, 145,700 people died of measles. Last year several hundred new cases were reported in the U.S., the largest outbreak in almost 20 years.  Parents have elected not to vaccinate their children because they can; 19 states have philosophical exemptions to vaccination, and 47 have religious exemptions. Between October 1990 and June 1991, 1,400 people living in Philadelphia were infected with measles and nine children died.  The Centers for Disease Control (CDC) found that the deaths had nothing to do with a new strain, and “everything to do with the parents.” They have recently reported that one-third of all children between 1-3 years have not been immunized. The percentage of American who believe vaccines are safe or effective is only 53%.

One estimate (JAMA) suggests that from 1924 to 2012 childhood vaccinations prevented more than 100 million cases of serious disease. The fundamental question is: do parents’ right to raise their children justify their decisions to not to vaccinate, thus putting the entire community at risk for disease?

Stay tuned.

Martin F. Sturman, MD, FACP

copyright 2015, Mathemedics, Inc.

 

The Electronic Medical Record: Promises and Perils

Wednesday, April 8th, 2015

Nothing is so dangerous as being too modern; one is apt to grow old-fashioned quite suddenly.

Oscar Wilde 

We are in an age of what I like to call  “techno-political” power disorders profoundly affecting the practice of medicine. One of many new pathologies afflicting our present system of health care is  conversion to electronic medical (or Health) records (“EMR”, “EHR”) which is being mandated this year.

A Brief History

In 2005 the influential RAND Corporation issued an exceedingly optimistic report, widely praised within the technology industry, predicting that widespread use of electronic medical records could save the United States health care system at least $81 billion a year. The report, paid for by a group of companies, including General Electric and Cerner Corporation, helped propel an explosive growth in the electronic medical records industry. After years of behind-the-scenes lobbying by Allscripts, Cerner and other companies, the efforts finally paid off. In February, 2009 the Obama administration and Congress authorized billions of dollars in federal stimulus money to help hospitals and doctors pay for the installation of electronic records systems.

Today, as doctors and hospitals struggle to make new records systems work, Allscripts, annual sales have more than doubled since 2009 to an estimated $1.44 billion last year while Cerner’s revenue has nearly tripled in eight years to a projected $3 billion this year.  According to Kalorama, a New York City-based research firm and probably the top healthcare database, six companies earn over half the $17.9 billion revenue in the EMR/EMH market.

Who’s Going Paperless and What’s the Cost?

This year, 2015 the federal mandate to switch to electronic health records (EHR) will have effected almost 30% of American physicians still using mostly handwritten charts. Presumably, 70% of physicians and hospitals are already being enmeshed in the digital record-keeping world. These mandates, continuing to unfold, define how health care providers qualify for Medicare and Medicaid EMR “meaningful use” payments.

The change to electronic medical records systems is heralded as bringing “compelling” benefits in the form of more efficient care, easier billing, and establishing the ability to access and share patient records from any location. All of these advertised advantages presumably will bring better patient outcomes and, (and, of course, save lives.)

As to who’s going paperless, it’s not just the 70% of doctors and most hospitals who think they’re already in the game, let alone the others who haven’t tip-toed-or jumped in yet. For starters think of all the unintended consequences: upfront costs of software licenses, additional computers, and the process of converting paper records to computer databases and how far to go back to begin data entry (certainly years for some chronic patients), conversion estimated to take 6 months to a year. $15,000 to $70,000 investment on the line for an average practitioner, although partial Government reimbursement over five years will be available. There are  more hidden costs such as expense of staff training, hiring additional IT technicians, and paying for inevitable upgrades.  There’s even a new growth industry consisting of EMR scribes,  A Medical Scribe is advertised “is essential to the physician’s daily duties  (and) relieves the practitioner of documentation and information gathering, all while insuring meaningful use is achieved. The medical scribe ensures accurate charting, efficient patient visits and quality patient care.”

While proponents brag that computerized record-keeping technologies will ultimately reduce costs and improve care, profits and sales are soaring now across the entire EMR records industry. Dr David Ludwig, Chief Operating Officer of a primary care network in Alberta, Canada observes, “Most often the benefits of adopting electronic medical records don’t accrue to the physicians themselves… the benefits accrue to patients and insurance companies.” “Patients?”-yes and no.  Insurance and new Industries, “yes.” Physicians: yes and no. EMR is coming, but it won’t be a picnic. This is a good spot to recall that old adage, “Just follow the money.”

Martin F. Sturman, MD, FACP

Copyright 2015, Mathemedics, Inc.