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July 28, 2008

Doctor -- reveal thyself

by Peter Pitts

The other day I attended a seminar (sponsored by Pfizer) at the New York Academy of Sciences. (40th floor at 250 Greenwich Street -- what a view!)

But the views offered on the inside were equally stimulating.

A few examples:

Elizabeth Teisberg (Professor, Darden School of Business, University of Virginia):

"Today pay-for-performance" means "pay-for-process-compliance."

Dr. J. Edward Hill (Past President, American Medical Association):

"If we believe in evidence-based medicine, then we should consider the evidence of what government run healthcare provides."

Dr. Hill also posed this interesting question, "Can we really have personalized care provided by the government?"

Dr. Michael McGinnis (Senior Scholar, Institute of Medicine):

"40% of deaths in the US are caused by the behavioral choices we make," led by lack of diet, not enough exercise -- and tobacco.

He also pointed out that "what happens at the intersections of the domains of influence" is what drives both health and care. McGinnis defined the relevant "domains of influence" as Behavioral, Genetic, Social, Environmental, and Healthcare.

There was much heated debate and audience participation -- but the most memorable comment was also one of the pithiest and it came from Dr. Hill who said, "People need to quit being complacent."

And included on that list of people needs to be doctors.

(Yes, doctors are people too.)

I asked Dr. Hill why we only hear from doctors when it's about their payment schedules. His reply was honest -- "I was afraid someone was going to ask me that question."

And that's when he offered the remark about complacency.

Posted by peterpitts at 08:58 AM
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July 22, 2008

Fellowship-shape

by Peter Pitts

The FDA said last Thursday it will launch a two-year fellowship program for physicians, chemists, statisticians and other science professionals interested in food and drug regulation. About 30 to 40 fellows will be accepted for the first program, which begins in October. Some of those accepted are expected to stay on as full-time employees after completing the program, which includes course work and seminars.

This is crucial since the average age of the FDA's work force is 54, and about 30 percent of general staffers already are eligible to retire.

That’s why “a strong FDA” is part of the agency’s five year strategic plan.

FDA’s most proprietary and valuable resource comes through the door each morning. There are almost 1,500 people with PhDs at FDA and well over 400 with medical degrees – and that’s without double counting.

An organization that can keep up with the rapid changes in the industries that it regulates, and that is capable of developing and implementing effective and innovative public health measures, requires a very special workforce. The FDA’s mission depends more than ever on a solid cadre of experienced physicians, toxicologists, chemists, statisticians, mathematicians and other highly qualified and dedicated professionals. Their expertise is essential for making regulatory decisions that are balanced and fair and timely -- and for keeping the agency on the cutting edge of the technology and sciences used by industry.

Agency leadership must make it a priority to encourage creativity, efficiency, and superior performance - an environment that attracts and retains top-quality scientists, and enables them to do top-quality work as part of an effective team.

Posted by peterpitts at 09:04 AM
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July 18, 2008

CCHIT Happens

by Peter Pitts

From the pen of Secretary of Health and Human Services Mike Leavitt:

Commission’s rigorous testing helps ensure interoperability of technology

As Congress takes up the subject of health information technology, it must take great care to enable accelerated progress rather than sending the process back to the starting line.

My vision of health information technology in the United States is a world where medical information can be privacy-protected and managed in a way that produces better quality, lower costs, fewer medical mistakes and less hassle for everybody. Building such a system requires that clinics, hospitals, pharmacies, labs and patients have systems that speak the same language — that are “interoperable.”

Getting health information systems in various parts of the healthcare system to work together requires the adoption of common technical standards. I’ve often compared the problem to the building of railroads. Before the railroads of the East, West, North and South could be interoperable, they all had to agree on one standard track size. A similar process is required with health IT, except that the degree of difficulty is much harder than just agreeing on a track size.

There are more than 200 developers of electronic medical record systems in the United States.

Until three years ago, there was no process for harmonizing and coordinating the standards they used. To remedy this problem, we formed the American Health Information Community (AHIC). It has succeeded, and as time passes we are seeing an accelerating stream of solid and widely accepted health IT standards emerge.

People who buy systems need to know they are making an investment that will connect them with the rest of the medical world. Today, they can buy with confidence.

The Certification Commission for Healthcare Information Technology gives systems a rigorous testing to demonstrate interoperability. Those systems that pass the test are given CCHIT certification. When doctors buy systems with that seal, they know that they are on a pathway to interoperability. This has given many doctors the confidence to buy who were waiting before.

We have seen more progress toward interoperability in the past three years than in the previous two decades. This is because government agencies, the medical family, the insurance industry and the health IT sector are all working together collaboratively. This type of collaboration is hard and requires great effort, but it is working, and its momentum is increasing.

As Congress begins to write a health IT bill, it is critical that it be crafted in a way that does not interrupt this success by imposing government controls. Government has to be at the table as a full participant, but if the bill prescribes the way these standards are to be set, or puts in place a politically controlled process that picks winners and losers, it will devastate a healthy but fragile process and lose three years of maturity and momentum.

I would offer three principles to members of Congress in dealing with legislation:

First, let’s protect the flexibility of those who are working to invent new tools, and let’s not undermine the work on AHIC that is already underway. Writing legislation to bias the process in one direction or another will constrict innovation and slow the process.

Second, let’s not try to solve all the privacy challenges of the 21st century in a health IT bill. We have to be careful to avoid penalizing early adoption.

Third, let’s respect the need for legitimate healthcare communications. We have to find the balance here. It is in the patient’s best interest for doctors and the patient to have information.

The most important thing government can do is adopt the standards ourselves. The adoption of standards by Medicare, the Veterans Administration, the Department of Defense, and Indian Health, is critical.

We’re making progress on health information technology. Let’s make sure that any legislation accelerates the progress already under way, rather than chilling it with requirements that the government dictate one-size-fits-all answers.

Posted by peterpitts at 08:04 AM
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