Wednesday, May 30, 2007

Doctors Go Online !

Dear Friends and Colleagues:
Attached an interesting article from todays New York Times.
The author makes a good point:
"Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks."
The question remains if his preference for WorldVista is really the solution for the problem. A one-size-fit-all product may not be the solution. But a cost-effective, customizable and scaleable solution could lower the threshold for those doctors who are still looking for a suitable product.
Look forward to your comments.

New York Times
May 30, 2007
Op-Ed Contributor
Physician, Upgrade Thyself


GO into almost any medical office, hospital or clinic in the United States and your records will still be handled the old-fashioned way — on paper. You can use a computer to pay your taxes, to program your TiVo or to read a message from your great-aunt, but your doctor has to practically level a forest just to examine your medical files. The cost, however, isn’t calculated in trees but in human lives: Electronic medical records would reduce the risk of medical errors and spare hospitals the expense of missing records and unnecessary treatment.

Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.

The program, WorldVistA, is based on the Veterans Affairs Department’s electronic-records system, called VistA (short for Veterans Health Information Systems and Technology Architecture — and yes, they beat Bill Gates to the name). VistA stands as perhaps the greatest success story for government-developed information technology since the Internet itself.

Using the VistA record system, the veterans department has managed to improve nearly every benchmark of quality in health care. In a decade, the department increased its pneumonia vaccination rate among at-risk patients to 94 percent from only 29 percent. That translates into 6,000 saved lives and $40 million saved each year from fewer pneumonia hospitalizations. On a host of other benchmarks — beta blocker use, cancer screening, cholesterol screening and so on — the department outperforms the nation’s best care.

Thanks to VistA, costs per patient at the Veterans Health Administration system are 32 percent lower, using inflation-adjusted dollars, than they were a decade ago. Over the same period, the medical consumer price index has increased 50 percent for the country as a whole.

The patients are happy, too. For the past eight years, the Veterans Health Administration has outscored private-sector health care in the independent American Customer Satisfaction Index. And because VistA is government-developed software, we all own it — it’s in the public domain. But while the government will mail you a copy, it won’t help install it or maintain it. The Department of Veterans Affairs is, in fact, prohibited by law to stray from its mission to serve veterans.

So in 2002, a group of former Veterans Affairs programmers and open-source advocates formed WorldVistA. They set about making a version of VistA that was simple for health care providers to use, and the fruit of their effort is now ready for market. Like VistA, WorldVistA is robust and fast. In April, the software was approved by the Certification Commission for Healthcare Information Technology. The certification means that WorldVistA is ready for broad adoption.

The effort to promote WorldVistA is supported by a grant from the Centers for Medicare and Medicaid Services, the agency that sets the prices for Medicare and Medicaid payments. The agency wants to provide clinics and public hospitals, especially those that serve uninsured and underserved patients, with an inexpensive system for electronic medical records. The agency was also just getting tired of seeing another year go by without a significant increase in the adoption of digital records. Right now, only a quarter of office-based doctors use them.

The problem isn’t a lack of software. There are hundreds of companies hawking electronic-records systems. But they don’t come cheap. The average cost is about $33,000 per doctor, plus another $1,500 a month per doctor for maintenance, according to a study published in the policy journal Health Affairs. For a small clinic with one or two doctors, that price is usually out of reach. For major hospitals, installing a new system can quickly become a multimillion-dollar experiment.

WorldVistA, thanks to its public-domain origins, costs about one-tenth of what a proprietary system does for a license fee and a support contract. And like any good open-source project, it’s constantly improving. A community of programmers fixes glitches and adds features, just as is done for the open-source Firefox browser and the Linux operating system.

And WorldVistA can be scaled up or down. It can work for neighborhood clinics, small-town hospitals, hospital systems, or, well, the Department of Veterans Affairs. WorldVistA’s big promise is that it can become the nationwide standard for electronic medical records, the backbone of a national network of health care. Your medical records could be read instantly and understood (perhaps less instantly) by any provider, anywhere.

Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.

WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.

But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care. If only it could upgrade the waiting-room magazines, too.

Thomas Goetz is the deputy editor of Wired magazine and author of the blog Epidemix.

Saturday, May 05, 2007

Abortion Measure Fails

Attached an article from the Miami Herald reporting that the abortion measure introduced by Rep. Trey Traviesa, a Tampa Republican, died in the Senate.
The proposed measure would have made it more diffcult for women tto access family planning services.
Obviously, in the Senate cooler heads prevailed recognzing that women's right to choose should not be curtailed.
Bernd Wollschlaeger,MD

Posted on Sat, May. 05, 2007
Lawmakers can't reach a consensus on abortion bill

No 24-hour wait periods. No preabortion sonograms. No court-appointed guardians for underaged girls trying to bypass the state's parental notification laws.
In fact, Florida won't see any abortion-law changes at all this year, after a controversial bill bounced back and forth between the state House and Senate in the final hours of session, dooming the proposal.

The legislative tennis match started when senators stripped the controversial proposal by Rep. Trey Traviesa, a Tampa Republican, of its controversial provisions.

Among them: a mandated 24-hour wait period and a sonogram before all abortions, with the requirement that doctors give women a chance to see the ultrasound scan.

But when the bill left the Senate and headed back to the House, it contained a list of criteria judges must consider when granting pregnant girls a waiver to Florida's parental-notification requirement.

In the House, Traviesa rejected the bare bones bill and sent it back to the Senate.

That's where the proposal died. The Senate ended the session without taking the bill up again.

The Senate compromise just wasn't acceptable for House supporters, Traviesa said.

''Do we take something small and call it something good?'' Traviesa asked. ``No, we don't.''

Wednesday, May 02, 2007

Politicians At The Bedside

Dear Friends and Colleagues:

Attached a troubling news item reporting how politicians are interfering in the physician-patient relationship. I know that within our organization and our society at large , women’s right to choose their reproductive life is being hotly debated.
Unfortunately, the US Supreme Court not only decided to uphold the “Partial Birth Abortion” ban, but also adopted the terminology of the Pro-Life movement calling doctors providing such services “abortion doctors” and described the procedure known as intact dilation and evacuation or dilation and extraction as "partial-birth abortion".
In a further blow to the physician-patient relationship the Florida House voted last week
to impose a 24-hour wait period and a sonogram before almost all abortions.
This decision not only encroaches on women’s reproductive rights, but also inserts the politician into the physician-patient relationship.
Most women I have provided pregnancy termination advice and counsel come to my office after days or deliberation and do not need rules and regulation imposed by paternalistic politicians.
As a physician and my patients advocate I protest such government intrusion into the practice of medicine and call upon organized medicine to speak up in defense of women’s reproductive rights.

Yours truly,



Posted on Sat, Apr. 28, 2007
Abortion bill heads to Senate
A controversial proposal requiring a 24-hour wait period and a sonogram before almost all abortions passed the state House of Representatives on Friday and is on its way to the Florida Senate.
The House voted 71-42 in favor of the provisions, after roughly two hours of contentious debate. Both proposals were added to a bill by Rep. Trey Traviesa, a Tampa Republican, that would require judges to appoint a guardian for underage girls who want an abortion and seek to get around the state's parental-notification law.
''On every other medical procedure there is time, time for those important two words: informed consent,'' Traviesa said. ``And anyone who seeks to deny a woman the ability to achieve informed consent is not advocating for the rights of women. They're advocating for an idea.''
Women who are victims of rape, incest, domestic violence or human trafficking would be exempt from the sonogram requirement.

The House vote comes nine days after the U.S. Supreme Court upheld a federal government ban on a particular kind of late-term abortion, a decision pro-choice activists have said would encourage some states to attempt to chip away at abortion rights.
Legislatures in Georgia and South Carolina are considering similar ultrasound requirements. One South Carolina proposal also would require women to view the scans.
The proposal faces rough going in the Senate, where the version by Sen. Ronda Storms, a Valrico Republican, addresses only the parental-notification changes. And senators from both parties have said they are opposed to expanding Storms' bill to encompass the new House provisions.
Gov. Charlie Crist said he is unsure what he thinks about the 24-hour wait period.
''That might concern me,'' Crist said Friday. ``I better look at it, though.''
Supporters say the ultrasound and 24-hour waiting period help women make better medical decisions. The state already requires sonograms before abortions in the second and third trimesters. The proposal would add that requirement for the first three months of pregnancy, when most abortions take place.
The bill also gives women the option not to view the scan.
''If you read this bill, it doesn't do anything to take a way a woman's right to choose,'' said Rep. Kevin Ambler, a Lutz Republican. ``What it does is put a thoughtful deliberative process in place.''
But opponents say anti-abortion advocates have hijacked the parental notification bill to add provisions designed to create more abortion hurdles that trivialize a woman's decision to have an abortion.
''This bill demeans me in a way I have never felt demeaned before,'' said Rep. Kelly Skidmore, a Boca Raton Democrat. ``It suggests that I would be so cavalier about the decision to terminate a pregnancy that I should go back home and think it over as if I was out shopping and passed by a clinic and decided to pop in for an abortion. What an outrage.''
Miami Herald staff writer Marc Caputo contributed to this report.