Oh the marvels of technology, just sign in to Facebook and you can have Glenn Beck attack you too.  The pictures are classic!   Be sure you have a Facebook picture on your profile that you like as this is how it shows up.

This is the safe way to have him attack you, Barbara the Duck Czar, learned something new today, Ducks can be czars:)  BD 

Fox host Glenn Beck spent much of the last week claiming that a normal, everyday progressive was linked to Stalin, Elvis, Joe Biden’s cousin, and the guy who came up with the idea of taxes.

CNNBC | Breaking News, Weather, Sports, Tech, Opinions, and Multimedia | By You, For You, And About You

I believe that hospitals, in there effort to increase profits by lowering labor costs, have hired lesser qualified nurses and reduced the number of nurses working on every shift…regardless of the patient load. What else would explain the dramatic increase in hospital patients suffering from painful and even deadly decubitus uclers? In my opinion, 90%- 95% of all decubitus ulcers could be prevented if patients are turned or repositioned every two hours. This should be standard policy in every hospital. The medical literature is very clear on this issue…and hospital administrators know it.

If you, or any of your family members, have suffered a decubitus ulcer in any of the following Virginia hospitals, please share your experience on our blog. Your story might prevent others from suffering the same outcome.

Alleghany Regional Hospital; Bedford Memorial Hospital; Buchanan General Hospital; Carilion Brambleton Surgical Center; Carilion Franklin Memorial Hospital; Carilion Giles Memorial Hospital; Carilion Medical Center; Carilion New River Valley Medical Center; Carilion Tazewell Community Hospital; Center for Restorative Care and Rehabilitation; Centra Health; Clinch Valley Medical Center; Danville Regional Medical Center; Dickenson Community Hospital; Johnston Memorial Hospital; Lee Regional Medical Center; Lewis-Gale Medical Center; Memorial Hospital of Martinsville & Henry County; Montgomery Regional Hospital; Mountain View Regional Medical Center; New River Valley Surgery Center; Norton Community Hospital; Piedmont Day Surgery Center; Pioneer Community Hospital of Patrick County, Inc.; Pulaski Community Hospital; Roanoke Ambulatory Surgical Center; Russell County Medical Center; Smyth County Community Hospital; Surgery Center of Lynchburg; Twin County Regional Hospital; Wellmont Lonesome Pine Hospital; Wythe County Community Hospital

This month they are offering a discount on Baby Phat Scrubs with the special code below.  BD 

For a limited time, you can get a 15%  with Baby phat Scrubs by using the code duckbaby on your order!

Next time you need to order scrubs or other healthcare apparel, please check out their website and compare. 

Thanks again to ScrubsGallery.Com for supporting the Medical Quack!!

With our state in a serious budget crisis, Medicaid spending will likely be cut.

For illustration purposes only, lets say the following is true:

Granny, age 72, needs skilled care because she is diabetic and has lost her right leg below the knee. Granny needs to stay in a nursing home and because she has no assets, she qualifies for Medicaid.

The nursing home will take care of Granny but charges $145 a day. Medicaid agrees to pay Granny $145 a day. At this rate, there are 4 nurses on the night shift, meals cost the facility $3 a day to prepare, and the building has not been painted in years. Everyone wishes there was more money to fix up the place, but not this year.

Budget cuts roll in, and Granny’s Medicaid will now only pay $115 a day. If all the other residents (104 of them) have the same coverage with Medicaid, then the nursing home will be down $1138800 a year. (My math - $30 less a day, 104 people x 365 days in 1 year).

YUP - a $30 a day payment cut means the NH will have decreased income of $1,113,800 a year. How will they continue to operate? Where will they cut costs? Simple. They will have to cut
STAFFING.

Your night nurses just went down to 1 full time and 1 part time. This will happen because there are NO minimum staffing requirements in Virginia nursing homes. Granny’s meals will now be cut to $1.25 a day - and her care will get WORSE AND WORSE.

Sad but true folks. Budget cuts in Virginia will almost guarantee more nursing negligence and malpractice for those who are not private pay.

This is not a judgment, or even a political argument. It is just a fact.

Wheres Some of the Focus for Johnson and Johnson Revenue Cycles Legally Patented Stent Wars?

These legally patented stents are so expensive for hospitals to stock and have available, that many hospitals stock them on consignment in other words they are on the shelf and the hospital does not pay until it is implanted.  Take a clue here folks and think about how the ridiculous court battles continue to run this expense right up the flagpole.  

Anyway I read about billions of dollars at stake and millions spent, and yet an idea to save lives and check for recalls goes nowhere, so is the interest in making money or is there any interest with involving patient safety here too?   BD

Tags for Use in Healthcare Medical Stents, Medications - One Scan Away From Safety Information in Real Time

Johnson & Johnson isn’t the only party appealing a Delaware judge’s ruling that four of its patents are invalid, as Boston Scientific Corp. cross-appeals despite winning the case’s last round.

Boston Scientific Corp. (NYSE:BSX) may have won the most recent round in its stent patents war with Johnson & Johnson (NYSE:JNJ), but that didn’t stop the Natick, Mass.-based devices giant from cross-appealing a Delaware judge’s ruling.

The patents in question are at the heart of complicated legal wrangling involving Boston Scientific, its New Brunswick, N.J.-based rival and competitor/partner Abbott (NYSE:ABT). The dispute centers around Boston Scientific’s Promus stent, a private-label version of Abbott’s Xience V stent, and the JNJ subsidiary Cordis Corp.’s Cypher.

Boston Scientific files cross-appeal in stent patents suit against Johnson & Johnson | MassDevice - Medical Device Industry News

One of the issues involved computer problems, in the form of failure to network a key computer involved in treatment evaluation.

Now at the other end of the state, Pittsburgh, more prostate-related computer problems have occurred:

Prostate cancer test interpretation flawed
By Walter F. Roche Jr.
PITTSBURGH TRIBUNE-REVIEW
Friday, March 5, 2010

A computer programming error caused West Penn Allegheny Health System’s laboratory to send physicians incorrect interpretations of prostate cancer tests for 288 patients over 15 months.

Hospital officials say physicians who ordered the tests were advised about the errors in recent weeks. They were sent revised, corrected interpretations, said Dr. Jan F. Silverman, chairman of the Department of Pathology and Laboratory Medicine.

One wonders how such a “programming error” can occur.

Silverman said actual test results were correct, and most physicians would rely on those and not interpretations. He said hospital officials found no evidence that incorrect test interpretations resulted in delayed or improper care … The erroneous interpretations were provided on a test physicians use to assess whether patients need biopsies of their prostates. The test provides a comparison of total prostate specific antigen, or PSA, versus free or non-attached PSA.

That there was no apparent delayed or improper care was by happenstance. The purpose of health IT, however, is not to give physicians the opportunity to have a lucky day, or to have placed upon them the additional cognitive burden of deciding which is correct: the test results, or its interpretation.

This episode raises another question: in addition to whatever “programming error” caused this problem, was there no QC of the actual reports to ensure the “interpretation” matched the pathological, serological and other results and findings?

Dr. Ralph Miller, head of the Allegheny Prostate Cancer Center, said it was “theoretically possible, but very, very unlikely” that erroneous interpretations resulted in delayed or improper care.

[That may be true, but is it due to luck and/or the inconvenient fact that most physicians 'did not rely' (i.e., ignored) the computer-generated interpretations? Also, will luck run out the next time a "programming error" occurs, resulting in dead patients? - ed.]

Silverman said those interpretations were sent between Oct. 1, 2008 and January. Of 818 PSA tests the West Penn Allegheny Core Laboratory performed during that period, 412 included comparisons of the two PSA figures. Of those, 288 included incorrect interpretations of that ratio, Silverman said.

That’s a very high percentage of error. Should that have occurred in a drug trial, the FDA would likely have been all over the responsible parties. However, health IT is unregulated, therefore all that’s required is an “please excuse us, we’ll do better the next time” from the involved parties.

The programming error was discovered recently when a physician questioned an interpretation, Silverman said.

I have written before on these electronic pages that physicians and clinical settings should not be the testing labs for IT personnel, with the clinicians using their clinical skills in locating programming bugs.

– SS

As stated below if the territories do not sign up, it will go to the polls at the elections due later this year and yes there are some pretty steep taxes here for the support and services.   They too have had issues with paying physicians as reported a year ago.

Hospitals across Australia Dealing with Crisis Situation

I had this story where the hospitals were having to get supplies from the local vet back in 2008.

Hospital ‘gets supplies from local vet’ Australia

What happened when their health insurance premiums went up, 750,000 ditched coverage, so it was not working well and the increases here were from 4 to 10 percent to be passed on, not as high as what we are looking at from 10-39%. 

Premiums up as 750,000 ditch cover Australia

But even as they ditched their insurance carriers, Australia still has the Dole to take care of those who need care to fall back on and it appears from this article the Dole is up for some significant upgrades and improvements through taxes. 

Health insurance to rise in Australia Same Issues, Different Country but they do have the Dole

They have designated a fund for the additional revenue in the National Hospital Fund.  With our healthcare being debated and the soap opera type of show we have going on in Washington, I thought as a comparison this was interesting to see what other countries are doing to tackle the challenge of reform.  We do have folks in positions that are non participants with their own use of Health IT, so thus the understanding and comprehension needed to create laws for citizens is getting real sticky and difficult, with emotional outcries on items that seem to make no sense to the big picture in Washington regarding reform. 

At the World Tourism Health Conference this year I spoke with an Australian business development manager from a hospital in Brisbane who was also there exploring opportunities.  He stated that internally they somewhat are already doing an internal tourism effort within the country, I would guess similar to what we do here in the US with different states, but he felt that the business model they used is not that entirely different from a world tourism concept.

This will be interesting to follow and see how their journey into healthcare reform shapes up with these monumental changes.  BD 

In what he called the most significant reform since the introduction of Medicare, Australias Prime Minister, Kevin Rudd, announced that the government would take over 60% of the funding of the country’s hospital system in exchange for about one-third of the Australian states goods and services tax (GST) revenue.

The government, he said, would build a new national health and hospital network to deliver better health and better hospitals by establishing a national network that is funded nationally, and run locally. The eight state-run systems will become part of one national network. There will be one set of national standards to drive and deliver better hospital services.

Whereas all revenues currently raised by the GST are re-distributed to the states, the government would take around one-third of those revenues, he disclosed, and place it in a new National Hospital Fund to be spent only on health and hospitals.

We will fund 60% of recurrent expenditure on research and training functions undertaken in public hospitals, he reiterated. We will fund 60% of capital expenditure - both operating and planned new capital investment - to maintain and improve public hospital infrastructure. Over time, we will also pay up to 100% of the efficient price of primary care equivalent outpatient services provided to public hospital patients.

In exchange for relieving pressures on state budgets from hospital funding, the government will require system-wide reforms to create a better integrated, unified national health and hospitals network, with national standards, national transparency and national accountability.

He will put the health reform package the states on April 11 at the next meeting of the Council of Australian Governments. If the states and territories do not sign up to the reforms, the government will take the package to the next election due later this year.

Australia Announces Healthcare Shake-up

[Note: this is not to denigrate the military, and I am very thankful to all who serve and defend our country and freedoms. HIT problems seem unfortunately universal - ed.]

The interface attempt, likely done by the usual actors in the traditional “business IT” manner has resulted in the predictable:

Glitch prompts VA to shut e-health data exchange with Defense
NextGov.com
By Bob Brewin 03/04/2010

The Veterans Affairs Department closed off access to the Defense Department’s huge electronic health record system on Monday because it found errors in some patients’ medical data clinicians downloaded from the Defense network, according to a departmental patient safety alert, which Nextgov obtained.

Although no patient was injured, the errors shed light on how software glitches could affect the accuracy of electronic medical records and a planned national system that has been backed by the Bush and Obama administrations.

“Shed light on how software glitches could affect the accuracy of electronic medical records?“

As my early medical mentor, Hahnemann cardiothoracic surgery pioneer Victor P. Satinsky would have said about purveyors of such wisdom: they are Masters of the Obvious.

I ask:

Why do we keep needing to “shed light” on the blatantly obvious, in your face, computer science 101 reality about electronic information systems? The light was shed when the first stored-program computers were developed in the late 1940’s.

Exactly how much light do we need to shed before IT personnel “get it” about the need for the most extreme diligence in IT-based medical records?

Perhaps the light of a dozen supernovas?

Is this the amount of light it will take before the IT world “gets it” about the need for the utmost engineering rigor in healthcare IT? (click image to play video).

It’s fortunate the error was found in a somewhat less than life-threatening manner:

VA first discovered the problem in late February, when one of its doctors accessed the Defense health records system, called AHLTA, to review the prescription information of a female patient. The data showed a Defense physician had prescribed her an erectile dysfunction drug. The VA doctor suspected the system displayed erroneous information [although females have been known to use these drugs- ed.] and a check with the Defense medical facility that supposedly prescribed the drug informed VA that the data was wrong and the VA query had returned information for another patient.

… When doctors queried the Defense system for patient information, they received no data, a portion of the data, incorrect information, or the complete, correct data for the patient, according to the alert.

[Where have I seen these types of patient data errors mentioned recently? Perhaps at my recent post "FDA on Health IT Adverse Consequences: 44 Reported Injuries And 6 Deaths In Two Years, Probably Just Tip of Iceberg" ? - ed.]

The glitch did not cause harm to any patient, but “the potential exists for decisions regarding patient care to be made using incorrect or incomplete data,” said Jean Scott, director of the Veterans Health Administration’s Information Technology Patient Safety Office, in the alert issued on Wednesday.

Indeed.

“The VA clinician may see the patient’s data during one session, but another session may not display the data previously seen,” the alert noted. “This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports.”

I would add that “intermittent errors” are by definition unpredictable. This is the most dangerous type of IT malfunction of all.

Until those systems are reactivated, VA doctors will have to obtain a patients’ health information from their paper medical files, faxes or PDF attachments that are e-mailed to the physicians, Scott said.

What? That old-fashioned, unreliable 5,000 year old artifact upon which the foundations of modern medicine were built, and favored by Luddites?

The errors occurred in the Bidirectional Health Information Exchange, a project started in 2004 that allows clinicians in VA and Defense to view health information in patient files. Older code in the system became stressed at peak periods when clinicians were making the most number of queries, said Roger Baker, chief information officer at VA. At these times, the system did not clear out a memory cache, resulting in memory leaks “so that information from one patient is presented as it is from another,” he explained.

Good software and information architecture engineering practices call exactly for testing under stress. Failure to clear caches, memory leaks, etc. are fundamental flaws that should never be permitted to see the light of day in clinical settings. That is what acceptance testing is designed to do. That’s what mission critical software undergoes in other sectors. That is what drug and device clinical trials are designed to do.

At this link, for example, is NASA’s Certification Processes for Safety-Critical and Mission- Critical Aerospace Software from 2003 (PDF). From that document:

… Since safety-critical aerospace software is prevalent and important to human life, what is the rationale behind certification of such software? In other words, how do engineers know when a new software product works properly and is safe to fly? In the United States, software must undergo a certification process described in various standards by various regulatory bodies including NASA and the Requirements and Technical Concepts for Aviation (RTCA) which is enforced by the Federal Aviation Administration (FAA).

There are no analogous requirements or enforcement in the healthcare IT sector. None.

VA has fixed the bug and plans to bring the BHIE back online on March 9. Baker emphasized the bug’s effect on the medical records of patients that VA and Defense clinicians share was sporadic and occurred in one out of 100 queries. The glitch caused errors only in the records that VA clinicians accessed. Defense doctors still have access to records Veterans Affairs stores.

“Only” 1 out of 100 … that’s only 10,000 errors per million EHR queries. Not too bad at all … how many soldiers are in a military division?

Baker said the department’s response to the glitch showed VA’s overall health system worked “because there is always a doctor in the loop” who checks the accuracy of a patient’s health data in combination with a well established patient safety organization that quickly alerts clinicians to any errors.

The “system worked” because luck prevailed that fallible, busy human clinicians were not deceived by erroneous information provided by a computer? I fall back on first principles of IT:

A computer can free professionals from tedious, repetitive work which does not require judgment. It can provide facts and figures with lightning speed, giving domain experts more time to exercise their judgment thoughtfully

The system is not working when computers add to the tedium, and having to expend precious cognitive capacity in ferreting out computer errors is certainly in that category. This excuse reminds me of a recent quote from our Homeland Security secretary about how the “system worked” when an airplane nearly was blown out of the sky.

These failure excuses, possibly written by a public relations ’spin doctor’ in an effort at damage control, remind me of a humorous sign I bought in a novelty store once, for placing on the wall: “Our policy is to always blame the computer.”

Perhaps clinicians need to stand up for this motto: No more alpha and beta software rollouts in healthcare.

Robert Charette, a risk management consultant and president of the ITABHI Corp. in Fredericksburg, Va., which consults with Defense, said VA was lucky it discovered an error as obvious as prescribing an erectile dysfunction drug for a female patient. He wondered if VA would have detected the error if it were for drugs with similar names, adding that despite the low error rate, “it’s the one out of 100 that can bite you.”

It’s also the one out of fifty thousand that can bite you, for instance as Merck recently discovered.

Baker said the complexity of medical records systems like BHIE would make regulating such networks [by agencies such as FDA - ed.] a daunting task.

I thought we were just at the point of transforming health with one thunderous click of a mouse after another per our prior HHS secretary at the 2005 HIMSS summit. Perhaps not…

Dave deBronkart, a patient advocate in Nashua, N.H., who spoke at last week’s Health IT Policy Committee meeting, said in an interview with Nextgov that the glitch paralleled the problems he encountered last year when he tried to transfer information from his hospital medical record to Google Health, an online electronic health record database the search giant launched in 2008.

I wrote about that at “Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?” here.

If the United States wants to develop a national health electronic record system, it needs to make sure heath information exchanges work correctly, said deBronkart, who added VA should be commended for reacting quickly to the software problem and issuing the patient safety alert.

I believe this is not possible under the current leadership, organizational and regulatory structures found in the healthcare IT sector. As I’ve written before, healthcare cannot be ‘reformed’ or even improved by IT, until IT and its culture are themselves reformed.

For more on these issues, see my site below.

– SS

PositiveID Corporation’s Health Link Personal Health Record First PHR to Communicate Real-Time Blood Sugar Readings for Diabetics and Their Caregivers/Physicians

Privacy-loving Americans have roundly rejected the idea of implanting microchips within their bodies, but one in four Germans is enthusiastic about the idea of having a chip implanted as long as there are tangible benefits involved. Those benefits dont even have to be of the life-and-death nature; some said they would implant a chip simply to make a shopping experience more enjoyable.

A poll released Monday in anticipation of Europes CeBIT trade show indicated that 23 percent of Germans are open to the idea of implantable microchips. The largest contingent (16 percent) said they would do it to help emergency services respond to them more quickly and effectively in case of an accident.

One Quarter of Germans Would Embrace an Implantable Microchip | Popular Science