Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Cost. Show all posts
Showing posts with label Cost. Show all posts

Wednesday, February 1, 2023

Ethics Consult: Keep Patient Alive Due to Spiritual Beliefs?

Jacob M. Appel
MedPageToday
Originally posted 28 Jan 23

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel's 2019 book, Who Says You're Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

Alexander is a 49-year-old man who comes to a prominent teaching hospital for a heart transplant. While awaiting the transplant, he is placed on a machine called a BIVAD, or biventricular assist device -- basically, an artificial heart the size of a small refrigerator to tide him over until a donor heart becomes available. While awaiting a heart, he suffers a severe stroke.

The doctors tell his wife, Katie, that no patient who has suffered such a severe stroke has ever regained consciousness and that Alexander is no longer a candidate for transplant. They would like to turn off the BIVAD and allow nature to take its course.

Not lost on these doctors is that Alexander occupies a desperately needed ICU bed, which could benefit other patients, and that his care costs the healthcare system upwards of $10,000 a day. The doctors are also aware than Alexander could survive for years on the BIVAD and the other machines that are now helping to keep him alive: a ventilator and a dialysis machine.

Katie refuses to yield to the request. "I realize he has no chance of recovery," she says. "But Alexander believed deeply in reincarnation. What mattered most to him was that he die at the right moment -- so that his soul could return to Earth in the body for which it was destined. To him, that would have meant keeping him on the machines until all brain function ceases, even if it means decades. I feel obligated to honor those wishes."

Monday, August 9, 2021

Health Care in the U.S. Compared to Other High-Income Countries: Worst Outcomes

The Commonwealth Fund
Mirror, Mirror 2021: Reflecting Poorly
Originally posted 4 Aug 21

Introduction

No two nations are alike when it comes to health care. Over time, each country has settled on a unique mix of policies, service delivery systems, and financing models that work within its resource constraints. Even among high-income nations that have the option to spend more on health care, approaches often vary substantially. These choices affect health system performance in terms of access to care, patients’ experiences with health care, and people’s health outcomes. In this report, we compare the health systems of 11 high-income countries as a means to generate insights about the policies and practices that are associated with superior performance.

With the COVID-19 pandemic imposing an unprecedented stress test on the health care and public health systems of all nations, such a comparison is especially germane. Success in controlling and preventing infection and disease has varied greatly. The same is true of countries’ ability to address the challenges that the pandemic has presented to the workforce, operations, and financial stability of the organizations delivering care. And while the comparisons we draw are based on data collected prior to the pandemic or during the earliest months of the crisis, the prepandemic strengths and weaknesses of each country’s preexisting arrangements for health care and public health have undoubtedly been shaping its experience throughout the crisis.

For our assessment of health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States, we used indicators available across five domains:
  • Access to care
  • Care process
  • Administrative efficiency
  • Equity
  • Health care outcomes
For more information on these performance domains and their component measures, see How We Measured Performance. Most of the data were drawn from surveys examining how members of the public and primary care physicians experience health care in their respective countries. These Commonwealth Fund surveys were conducted by SSRS in collaboration with partner organizations in the 10 other countries. Additional data were drawn from the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO).

Wednesday, January 27, 2021

What One Health System Learned About Providing Digital Services in the Pandemic

Marc Harrison
Harvard Business Review
Originally posted 11 Dec 20

Here are two excerpts:

Lesson 2: Digital care is safer during the pandemic.

A patient who’s tested positive for Covid doesn’t have to go see her doctor or go into an urgent care clinic to discuss her symptoms. Doctors and other caregivers who are providing virtual care for hospitalized Covid patients don’t face increased risk of exposure. They also don’t have to put on personal protective equipment, step into the patient’s room, then step outside and take off their PPE. We need those supplies, and telehealth helps us preserve it.

Intermountain Healthcare’s virtual hospital is especially well-suited for Covid patients. It works like this: In a regular hospital, you come into the ER, and we check you out and think you’re probably going to be okay, but you’re sick enough that we want to monitor you. So, we admit you.

With our virtual hospital — which uses a combination of telemedicine, home health, and remote patient monitoring — we send you home with a technology kit that allows us to check how you’re doing. You’ll be cared for by a virtual team, including a hospitalist who monitors your vital signs around the clock and home health nurses who do routine rounding. That’s working really well: Our clinical outcomes are excellent, our satisfaction scores are through the roof, and it’s less expensive. Plus, it frees up the hospital beds and staff we need to treat our sickest Covid patients.

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Lesson 4: Digital tools support the direction health care is headed.

Telehealth supports value-based care, in which hospitals and other care providers are paid based on the health outcomes of their patients, not on the amount of care they provide. The result is a greater emphasis on preventive care — which reduces unsustainable health care costs.

Intermountain serves a large population of at-risk, pre-paid consumers, and the more they use telehealth, the easier it is for them to stay healthy — which reduces costs for them and for us. The pandemic has forced payment systems, including the government’s, to keep up by expanding reimbursements for telehealth services.

This is worth emphasizing: If we can deliver care in lower-cost settings, we can reduce the cost of care. Some examples:
  • The average cost of a virtual encounter at Intermountain is $367 less than the cost of a visit to an urgent care clinic, physician’s office, or emergency department (ED).
  • Our virtual newborn ICU has helped us reduce the number of transports to our large hospitals by 65 a year since 2015. Not counting the clinical and personal benefits, that’s saved $350,000 per year in transportation costs.
  • Our internal study of 150 patients in one rural Utah town showed each patient saved an average of $2,000 in driving expenses and lost wages over a year’s time because he or she was able to receive telehealth care close to home. We also avoided pumping 106,460 kilograms of CO2 into the environment — and (per the following point) the town’s 24-bed hospital earned $1.6 million that otherwise would have shifted to a larger hospital in a bigger town.

Friday, August 16, 2019

Physicians struggle with their own self-care, survey finds

Jeff Lagasse
Healthcare Finance
Originally published July 26, 2019

Despite believing that self-care is a vitally important part of health and overall well-being, many physicians overlook their own self-care, according to a new survey conducted by The Harris Poll on behalf of Samueli Integrative Health Programs. Lack of time, job demands, family demands, being too tired and burnout are the most common reasons for not practicing their desired amount of self-care.

The authors said that while most doctors acknowledge the physical, mental and social importance of self-care, many are falling short, perhaps contributing to the epidemic of physician burnout currently permating the nation's healthcare system.

What's The Impact

The survey -- involving more than 300 family medicine and internal medicine physicians as well as more than 1,000 U.S. adults ages 18 and older -- found that although 80 percent of physicians say practicing self-care is "very important" to them personally, only 57 percent practice it "often" and about one-third (36%) do so only "sometimes."

Lack of time is the primary reason physicians say they aren't able to practice their desired amount of self-care (72%). Other barriers include mounting job demands (59%) and burnout (25%). Additionally, almost half of physicians (45%) say family demands interfere with their ability to practice self-care, and 20 percent say they feel guilty taking time for themselves.

The info is here.

Sunday, June 30, 2019

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
www.businessinsider.com
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Monday, May 20, 2019

How Drug Companies Helped Shape a Shifting Biological View of Mental Ilness

Terry Gross
NPR Health Shots
Originally posted May 2, 2019

Here are two excerpts:

On why the antidepressant market is now at a standstill

The huge developments that happen in the story of depression and the antidepressants happens in the late '90s, when a range of different studies increasingly seemed to suggest that these antidepressants — although they're helping a lot of people — when compared to placebo versions of themselves, don't seem to do much better. And that is not because they are not helping people, but because the placebos are also helping people. Simply thinking you're taking Prozac, I guess, can have a powerful effect on your state of depression. In order, though, for a drug to get on the market, it's got to beat the placebo. If it can't beat the placebo, the drug fails.

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On why pharmaceutical companies are leaving the psychiatric field

Because there have been no new good ideas as to where to look for new, novel biomarkers or targets since the 1960s. The only possible exception is there is now some excitement about ketamine, which targets a different set of biochemical systems. But R&D is very expensive. These drugs are now, mostly, off-patent. ... [The pharmaceutical companies'] efforts to bring on new drugs in that sort of tried-and-true and tested way — with a tinker here and a tinker there — has been running up against mostly unexplained but indubitable problems with the placebo effect.

The info is here.

Wednesday, November 7, 2018

Hospitals are fed up with drug companies, so they’re starting their own

Carolyn Johnson
The Washington Post
Originally posted September 6, 2018

A group of major American hospitals, battered by price spikes on old drugs and long-lasting shortages of critical medicines, has launched a mission-driven, not-for-profit generic drug company, Civica Rx, to take some control over the drug supply.

Backed by seven large health systems and three philanthropic groups, the new venture will be led by an industry insider who refuses to draw a salary. The company will focus initially on establishing price transparency and stable supplies for 14 generic drugs used in hospitals, without pressure from shareholders to issue dividends or push a stock price higher.

“We’re trying to do the right thing — create a first-of-its-kind societal asset with one mission: to make sure essential generic medicines are affordable and available to everyone,” said Dan Liljenquist, chair of Civica Rx and chief strategy officer at Intermountain Healthcare in Utah.

The consortium, which includes health systems such as the Mayo Clinic and HCA Healthcare, collectively represents about 500 hospitals. Liljenquist said that the initial governing members have already committed $100 million to the effort. The business model will ultimately rely on the long-term contracts that member health care organizations agree to — a commitment to buy a fixed portion of their drug volume from Civica.

The info is here.

Thursday, October 11, 2018

Pharma exec had 'moral requirement' to raise price 400%

Wayne Drash
CNN.com
Originally published September 12, 2018

 A pharmaceutical company executive defended his company's recent 400% drug price increase, telling the Financial Times that his company had a "moral requirement to sell the product at the highest price." The head of the US Food and Drug Administration blasted the executive in a response on Twitter.

Nirmal Mulye, founder and president of Nostrum Pharmaceuticals, commented in a story Tuesday about the decision to raise the price of an antibiotic mixture called nitrofurantoin from about $500 per bottle to more than $2,300. The drug is listed by the World Health Organization as an "essential" medicine for lower urinary tract infections.

"I think it is a moral requirement to make money when you can," Mulye told the Financial Times, "to sell the product for the highest price."

The info is here.

Friday, September 14, 2018

What Are “Ethics in Design”?

Victoria Sgarro
slate.com
Originally posted August 13, 2018

Here is an excerpt:

As a product designer, I know that no mandate exists to integrate these ethical checks and balances in our process. While I may hear a lot of these issues raised at speaking events and industry meetups, more “practical” considerations can overshadow these conversations in my day-to-day decision making. When they have to compete with the workaday pressures of budgets, roadmaps, and clients, these questions won’t emerge as priorities organically.

Most important, then, is action. Castillo worries that the conversation about “ethics in design” could become a cliché, like “empathy” or “diversity” in tech, where it’s more talk than walk. She says it’s not surprising that ethics in tech hasn’t been addressed in depth in the past, given the industry’s lack of diversity. Because most tech employees come from socially privileged backgrounds, they may not be as attuned to ethical concerns. A designer who identifies with society’s dominant culture may have less personal need to take another perspective. Indeed, identification with a society’s majority is shown to be correlated with less critical awareness of the world outside of yourself. Castillo says that, as a black woman in America, she’s a bit wary of this conversation’s effectiveness if it remains only a conversation.

“You know how someone says, ‘Why’d you become a nurse or doctor?’ And they say, ‘I want to help people’?” asks Castillo. “Wouldn’t it be cool if someone says, ‘Why’d you become an engineer or a product designer?’ And you say, ‘I want to help people.’ ”

The info is here.

Monday, August 13, 2018

This AI Just Beat Human Doctors On A Clinical Exam

Parmy Olson
Forbes.com
Originally posted June 28, 2018

Here is an excerpt:

Now Parsa is bringing his software service and virtual doctor network to insurers in the U.S. His pitch is that the smarter and more “reassuring” his AI-powered chatbot gets, the more likely patients across the Atlantic are to resolve their issues with software alone.

It’s a model that could save providers millions, potentially, but Parsa has yet to secure a big-name American customer.

“The American market is much more tuned to the economics of healthcare,” he said from his office. “We’re talking to everyone: insurers, employers, health systems. They have massive gaps in delivery of the care.”

“We will set up physical and virtual clinics, and AI services in the United States,” he said, adding that Babylon would be operational with U.S. clinics in 2019, starting state by state. “For a fixed fee, we take total responsibility for the cost of primary care.”

Parsa isn’t shy about his transatlantic ambitions: “I think the U.S. will be our biggest market shortly,” he adds.

The info is here.

Friday, June 8, 2018

The Ethics of Medicaid’s Work Requirements and Other Personal Responsibility Policies

Harald Schmidt and Allison K. Hoffman
JAMA. Published online May 7, 2018. doi:10.1001/jama.2018.3384

Here are two excerpts:

CMS emphasizes health improvement as the primary rationale, but the agency and interested states also favor work requirements for their potential to limit enrollment and spending and out of an ideological belief that everyone “do their part.” For example, an executive order by Kentucky’s Governor Matt Bevin announced that the state’s entire Medicaid expansion would be unaffordable if the waiver were not implemented, threatening to end expansion if courts strike down “one or more” program elements. Correspondingly, several nonexpansion states have signaled that the option of introducing work requirements might make them reconsider expansion—potentially covering more people but arguably in a way inconsistent with Medicaid’s broader objectives.

Work requirements have attracted the most attention but are just one of many policies CMS has encouraged as part of apparent attempts to promote personal responsibility in Medicaid. Other initiatives tie levels of benefits to confirming eligibility annually, paying premiums on time, meeting wellness program criteria such as completing health risk assessments, or not using the emergency department (ED) for nonemergency care.

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It is troubling that these policies could result in some portion of previously eligible individuals being denied necessary medical care because of unduly demanding requirements. Moreover, even if reduced enrollment were to decrease Medicaid costs, it might not reduce medical spending overall. Laws including the Emergency Medical Treatment and Labor Act still require stabilization of emergency medical conditions, entailing more expensive and less effective care.

The article is here.

Tuesday, December 19, 2017

Health Insurers Are Still Skimping On Mental Health Coverage

Jenny Gold
Kaiser Health News/NPR
Originally published November 30, 2017

It has been nearly a decade since Congress passed the Mental Health Parity And Addiction Equity Act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, amid an opioid epidemic and a spike in the suicide rate, patients are still struggling to get access to treatment.

That is the conclusion of a national study published Thursday by Milliman, a risk management and health care consulting company. The report was released by a coalition of mental health and addiction advocacy organizations.

Among the findings:
  • In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.

  • Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.

  • State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington, D.C., it was 63 percent.
The researchers at Milliman examined two large national databases containing medical claim records from major insurers for PPOs — preferred provider organizations — covering nearly 42 million Americans in all 50 states and D.C. from 2013 to 2015.

The article is here.

Friday, July 14, 2017

Social Mission in Health Professions Education: Beyond Flexner

Fitzhugh Mullan
JAMA: Viewpoint
Originally published June 26, 2017

Here is an excerpt:

Today, with a broader recognition of the importance of social determinants of health and a better understanding of the substantial health disparities within the United States, new ideas are circulating and important experiments in curricular redesign are taking place at many schools. Accountable care organizations, primary care medical homes, interprofessional education, cost consciousness, and teaching health centers are all present to some degree in the curricula of health professions schools and teaching hospitals, and all have dimensions of social mission. These developments are encouraging, but the creative focus on social mission that they represent needs to be widely embraced, becoming a core value of all health professions educational institutions, including schools, teaching hospitals, and postgraduate training programs.

Toward that end, the unqualified commitment of these institutions to teaching and modeling social mission is needed, as are the voices of academic professional organizations, accrediting bodies, and student groups who have important roles in defining the values of young professionals. The task is interprofessional and should involve other disciplines including nursing, dentistry, public health, physician assistants, and, perhaps, law and social work. The commitments needed are not the domain of any one profession, and collaborative initiatives at the educational level will reinforce social mission norms in practice. The precision with which health disparities and the morbidity and mortality that they represent can be documented calls on all health professions schools, academic health centers, and teaching hospital to place their commitment to social mission alongside their dedication to education, research, and service in pursuit of a healthier and fairer society.

The article is here.

Tuesday, August 23, 2016

Administration Paints Rosy Future For Obamacare Marketplaces

By Phil Galewitz
Kaiser Health News
Originally published August 11, 2016

Despite dire warnings from Republicans and some large insurers about the stability of the Affordable Care Act exchanges, an Obama administration report released Thursday indicated the individual health insurance market has steadily added healthier and lower-risk consumers.

Medical costs per enrollee in the exchanges in 2015 were unchanged compared with 2014, according to the Centers for Medicare & Medicaid Services. In contrast, per-member health costs rose between 3 percent and 6 percent in the broader U.S. insurance market, which includes 154 million people who get coverage through their employer and the 55 million people on Medicare, the report said.

Aviva Aron-Dine, senior counselor to U.S. Health and Human Services Secretary Sylvia Burwell, said the data was encouraging when many insurers have announced double-digit rate increases for 2017 and others have pulled back in some states to curtail financial losses.

The article is here.

Wednesday, February 10, 2016

End-of-life care in U.S. not as costly as in Canada

By Jessica McDonald
newsworks.org
Originally posted January 10, 2016

The United States has a reputation for providing costly -- and often unwanted -- end-of-life care. But the first study to do an international comparison finds it's not as egregious as we thought.

Compared with patients in other developed nations, Americans diagnosed with cancer spend more time in the intensive care unit and get more chemotherapy in the last months of their lives.

But fewer patients are in the hospital when they die. And the overall bill, while high, isn't the steepest. That honor goes to Canada.

"We found that end-of-life care in the United States is not the worst in the world, and I think that surprises a lot of people," said Dr. Ezekiel Emanuel, a medical ethicist at the University of Pennsylvania.

The article is here.

Tuesday, December 22, 2015

Is Gun Violence a Public Health Crisis?

Science Friday Podcast
Ira Flatow is the Host and Executive Producer

On Wednesday, a mass shooting in San Bernardino, California left 14 people dead, making it one of the deadliest in modern American history. In fact, there have been more mass shootings than there have been days in 2015 so far. Of course, gun violence in the United States isn’t restricted to mass shootings—firearm homicides and suicides far outpace the number of mass-shooting fatalities. Taken together, an estimated 32,000 people die as a result of gun violence in the United States annually, and an additional 180,000 to 190,000 people are injured, says Sandro Galea. He’s the dean of Boston University’s School of Public Health and one of a number of researchers calling for firearm deaths to be treated as a public health issue. Another is Garen Wintemute, of the UC Davis School of Medicine, who has done extensive research on the effects of access to guns. Wintemute and Galea join Ira to discuss why they see gun violence as a public health issue and what research must be done and steps taken to address the problem.

The podcast is here.

Saturday, November 7, 2015

The End of Expertise

By Bill Fischer
Harvard Business Review
Originally published October 19, 2015

Here is an excerpt:

Increasingly, expertise is losing the respect that for years had earned it premiums in any market where uncertainty was present and complex knowledge valued. Along with it, we are shedding our reverence for “expert evaluation,” losing our regard for our Michelin guides and casting our lot in with the peer-generated Yelps of the world.

Not only is the character of expertise changing, but at the same time, new client needs are emerging. Firms are fearful of being vulnerable to an unknown (not uncertain) future; and at the same time, conditioned by living in an internet world, they expect instant knowledge responses at reasonable prices. Expertise providers are finding that the models that they have long relied upon (e.g., the familiar five forces model) are losing some of their potency, as they are based upon assumed knowledge that is increasingly difficult to determine (What industry are we in? Who are our competitors? What are our core-competencies?), and are more like time-lapse photography in presentation than the customer’s contemporary expectations of real-time, virtual streaming engagement.

The entire article is here.

Saturday, May 17, 2014

U.S. Should Significantly Reduce Rate of Incarceration

Unprecedented Rise in Prison Population ‘Not Serving the Country Well,’ Says New Report

Press Release from the National Academy of Sciences
Released April 30, 2014

Given the minimal impact of long prison sentences on crime prevention and the negative social consequences and burdensome financial costs of U.S. incarceration rates, which have more than quadrupled in the last four decades, the nation should revise current criminal justice policies to significantly reduce imprisonment rates, says a new report from the National Research Council.

A comprehensive review of data led the committee that wrote the report to conclude that the costs of the current rate of incarceration outweigh the benefits.  The committee recommended that federal and state policymakers re-examine policies requiring mandatory and long sentences, as well as take steps to improve prison conditions and to reduce unnecessary harm to the families and communities of those incarcerated.  In addition, it recommended a reconsideration of drug crime policy, given the apparently low effectiveness of a heightened enforcement strategy that resulted in a tenfold increase in the incarceration rate for drug offenses from 1980 to 2010 — twice the rate for other crimes.

“We are concerned that the United States is past the point where the number of people in prison can be justified by social benefits,” said committee chair Jeremy Travis, president of John Jay College of Criminal Justice in New York City.  “We need to embark on a national conversation to rethink the role of prison in society.  A criminal justice system that makes less use of incarceration can better achieve its aims than a harsher, more punitive system. There are common-sense, practical steps we can take to move in this direction.”

The rest of the press release is here.

Tuesday, March 12, 2013

Ethics of Admission, Pt. II: Undergraduates and the Brass Ring

By Jane Robbins
Inside Higher Ed
Originally posted February 26, 2013

Here are some excerpts:

But what about students? Is it worth the chance at the brass ring? One could say there is no choice but get on the merry-go-round—and that is certainly what they are being told. But if we know that many will not get a shot because of where they are placed or when they got on or whether, metaphorically, they lack the height compared to the one behind them to reach the ring, is the current approach wrong—in both the incorrect and immoral senses of the word?

The inevitable is, of course, happening: people are beginning to question the value of a college degree for them as individuals. This is why, counterintutively, the push for the current wage data approach to value is completely wrong-headed and also, I think unethical. It is the individual that has been lost in the wholesale approach to commodity credentials and wage comparison, a particularly perverse kind of educational “channeling.” In the service of whose interests is, for example, the tireless emphasis on STEM and the disparagement of arts? Who will care when large percentages with STEM credentials can’t find jobs, experience depressed wages because there are so many of them, and find themselves with no transferable skills or habits of mind when technology moves on? If it is going to be difficult to find a job anyway, one should at least have followed one’s own interests. Education should allow you to choose your work, not vice versa.

On the constant merry-go-round, we seem to have forgotten that college, or any other education at any level except technical and some forms of professional education, is not to get a job, and certainly not to get a particular job. That is what trade school is for. We should be encouraging students who want a particular job -- a vocation -- to train elsewhere, perhaps with the idea of getting more and broader education at a later time.

The rest of the blog post is here.

Monday, January 28, 2013

In Second Look, Few Savings From Digital Health Records


By REED ABELSON and JULIE CRESWELL
The New York Times
Published: January 10, 2013

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The entire story is here.