A Conversation with Jeff Hall, PhD, Vice President of GenOptix

Tags

biomarkers, cancer, genomics, GenOptix, medicine, novartis, oncology, pharma, social media

By Gregg A. Masters, MPH

On Wednesday’s broadcast of This Week in Oncology our guest Dr. Jeff Hall makes his second appearance on the show. The topic was ‘Biomarkers: their emerging clinical significance in the diagnosis and treatment of cancer’.

Dr. Hall has over 20 years of experience in the life sciences industry, and is currently the Vice President of Clinical Education at GenOptix. He holds a BA in Biology and Chemistry from UC Santa Cruz and a PhD in Biochemistry from UC Berkeley. Dr Hall was the first author on the landmark 1990 Science paper describing the location of BRCA I on chromosome 17q.

GenOptix is division of Novartis. For broader context see webcast by Novartis CEO Joseph Jimenez to the JP Morgan Healthcare conference, and for the deck click here.

To listen to archived replay of broadcast, click here.

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Is It Safe?

Tags

cancer, digital media, ehr, emr, innovation, internet security, mat honan, oncology, social media

By Richard Just, MD

When I read William Goldman’s book “The Marathon Man” years ago, I recall the evil Nazi dentist with drill in hand (played by Sir Laurence Olivier in the subsequent movie) hovering over the un-anesthetized Dustin Hoffman strapped to a chair asking the question: “Is it safe?” Of course, Hoffman didn’t know. So when Olivier turned on the drill and Hoffman started screaming, everyone in the theater identified with his pain. I still get chills when thinking about it.

In previous blog post here, I’ve described the pain I experienced when we transitioned from paper charts to electronic medical records. Certainly not as intense as having dental work without anesthesia, but agony just the same. Well guess what! Now we’re transitioning to a new EMR. In many ways, our pain level has increased from 6/10 to 9/10.

I interviewed Casey Quinlan, of Might Casey Media, a very astute commentator on healthcare in general and cancer care specifically, on This Week in Oncology last Wednesday. The “Mighty Casey” made several cogent observations on EMR’s, but, we  really didn’t address the question of security. In the December 15-16, 2012 issue of the Wall Street Journal, Ellen E. Schultz  wrote an article entitled: “How Safe Are Your Medical Records?” Two pieces of legislation are cited:

The first is the Health Insurance Portability and Accountability Act (HIPAA) which “allows health-care providers to disclose medical records without a patient’s consent when the information used is for treatment, payment and ‘health-care operations.’ Providers are supposed to exchange only relevant information, but they commonly transfer a patient’s entire file, which is easier than separating the pertinent records.” In the same manner, protection can be lost for psychotherapy records if they are co mingled with other medical records.

Second is the American Recovery and Reinvestment Act of 2009 which “prohibits the unauthorized sale of medical records, requires that data be encrypted and mandates that individuals be notified of security breaches. It is too soon to say how effective these rules will be.”

Drilling down to the core problem is Mat Honan’s original article “How Apple and Amazon Security Flaws Led to My Epic Hacking” and follow-up video entitled “Mat Honan Hacked and Digitally Destroyed” he describes an “epic hack” that destroyed his entire digital life in 1 hour. Having been the victim of a phishing expedition, a minor nuisance compared to his experience, I know how it feels to have your identity stolen.  After researching how and why hacking has become more problematical, Honan concludes: “The age of the password has come to an end; we just haven’t realized it yet. And no one has figured out what will take its place.” He continues: “The ultimate problem with the password is that it’s a single point of failure, open to many avenues of attack. Two factors should be a bare minimum.” This creates the dilemma that if the password is too simple and obvious, it’s a no-brainer to crack; if it’s too complex and obscure, the password is hard to remember. And, we are advised never to write passwords down. Why am I not surprised that the most common password used is, in fact, “password”, and second is “123456”?

Honan provides a helpful Dos and Don’ts list to survive the “password apocalypse”:

“DON’T:

1. REUSE PASSWORDS. If you do, a hacker who gets just one of your accounts will own them all.
2. USE A DICTIONARY WORD AS YOUR PASSWORD. If you must, then string several together into a pass phrase.
3. USE STANDARD NUMBER SUBSTITUTIONS. Think P455wOrd is a good password? NOp3! Cracking tools now have those built in.
4. USE A SHORT PASSWORD-no matter how weird. Today’s processing speeds mean that even passwords like “h6!r$q” are quickly crackable. Your best defense is the longest possible password.

DO:

1. ENABLE TWO-FACTOR AUTHENTICATION WHEN OFFERED. When you log in from a strange location, a system like this will send you a text message with a code to confirm. Yes, that can be cracked, but it’s better than nothing.
2. GIVE BOGUS ANSWERS TO SECURITY QUESTIONS. Think of them as a secondary password. Just keep your answers memorable. My first car? Why, it was a “Camper Van Beethoven Freaking Rules.”
3. SCRUB YOUR ONLINE PRESENCE: One of the easiest ways to hack into an account is through your e-mail and billing address information. Sites like Spokeo and WhitePages.com offer opt-out mechanisms to get your information removed from their databases.
4. USE A UNIQUE, SECURE EMAIL ADDRESS FOR PASSWORD RECOVERIES. If a hacker knows where your password reset goes, that’s a line of attack. So create a special account you never use for communications. And make sure to choose a username that isn’t tied to your name-like m****n@wired.com so it can’t be easily guessed.”

So, the answer to the question: “Is it safe?” is an emphatic NO. Honan concludes that online identity verification will not be a password-based system in the future, any more than our system of personal identification will be based on photo-ID’s. But, passwords may still be involved as just one part of a multifaceted process.

Clinical Cancer Advances 2012 via @ASCO

Tags

cancer, evidence based medicine, innovation, medical education, oncology, participatory medicine, physician, social media, twitter

Now in its eighth year, Clinical Cancer Advances 2012 was developed under the guidance of an 21-person editorial board of leading oncologists, overseen by Executive Editors Nicholas J. Vogelzang, MD and Bruce J. Roth, MD.
Each year, the American Society of Clinical Oncology conducts an independent review of advances in clinical cancer research that have the greatest potential impact on patients’ lives.

This year’s report, Clinical Cancer Advances 2012: ASCO’s Annual Report on Progress Against Cancer, features 87 studies, 17 of which were designated as “major” advances by the report’s 21-person editorial board.

The large number of advances featured in this year’s Report affirms the remarkable payoff of national investments in clinical research on cancer prevention, screening, treatment and quality of life for patients with cancer.

For complete report, click here.

The ‘Oncology ACO’: Does it Have a Future?

Tags

accountable care, aco, affordable care act, cancer, FloridaBlue, health reform, innovation, obamacare, oncology ACO, US Oncology

By Gregg A. Masters, MPH

The best business model for oncology care is not yet obvious to me. But it is crystal clear that innovative new models are being hatched before our eyes.. via Oncology Times

Since CMS (via HHS) issued the final rule addressing ACO provisions and specifically ‘excluded’ oncologists from participating as ACO organizers, instead relegating their involvement in at least via the Medicare Shared Savings Program to ‘participants’, there has been rumbling underneath the surface of ‘ACO-dom’.

Perhaps as best evidenced by the April announcement of a tripartite venture between FlordiaBlue, Advanced Medical Specialties (a former US Oncology Affiliate now part of the McKesson fold), and Baptist Health System, the competitive positioning in the oncology market is not sitting idly by as other medical specialties, including primary care, carve out their niche and actively experiment with their version and local vision for accountable care aka ‘the triple aim.’

In the broader conversation on ACOs or their derivatives including medical homes or accountable care collaborations, etc, there has been much discussion from very smart and accomplished wonks including periodic banter, i.e., Goldsmith v. De Marco] as to the significance and forward [reasonably expected] benefits from duly organized [or in the latter case – arranged] ACOs. Bottom-line,  there is a fair amount of credible disagreement over whether these entities as variably configured actually make a difference?

Meanwhile, in the oncology domain, much of the action seems relegated to a few forward thinking players who have taken the initiative regardless of CMS’ decision to limit their participation (at least to this point in time) to contracted participant suppliers of specialty services.

For a deeper dive into the question: ‘Who Is Taking the Lead in Incorporating Oncology into ACO Thinking?’ see: The Rapidly Evolving ACO World, we have the following observation and summary data:

There are several examples of organizations that have stepped up and have taken the lead in exploring payment re-design in oncology, some within an ACO shared savings context and some outside the ACO context.

The vanguard includes:

• Consultants in Medical Oncology & Hematology. Oncology Patient Centered Medical Home®, Drexel Hill, PA
• United Healthcare (5 episode payment pilot sites)
• Texas Oncology/Innovent Oncology and Aetna
• Oncology Physician Resource (OPR) and Michigan Blue Cross
• Wilshire Oncology and Wellpoint, Southern California
• CareFirst Blue Cross pathways and medical home initiative, Maryland
• Priority Health oncology medical home initiative, Michigan
• Florida Blue, Baptist Health South Florida and Advanced Medical Specialties Oncology ACO, Miami
• Harvard Pilgrim Health Plan with oncology medical home demonstration pilot, Massachusetts;
• Innovative Oncology Business Solutions with CMMI Innovation Challenge grant to demonstrate value proposition of community oncology medical home (COME HOME) at 7 community oncology practices nationwide.

And certainly there will be more organizations joining the vanguard in the near future.

We are working on getting Ronald Barkley, CCBD Group, and Linda Bosserman, MD, President and CEO of Wilshire Oncology respectively to share their thoughts on ‘This Week in Oncology’. We’ll keep you posted when we’re able to lock them down.

Meanwhile, with the elections now behind us, the future is rather clear at least for those who want to manifest the spirit and intent of the Affordable Care Act, so ‘warp drive Mr. Zulu’ as the ACO movement shifts into overdrive.

Can ‘Social Media’ Bridge the Gap Between Payers and Oncologists?

Tags

@tumorboard, cancer, digital media, health, innovation, managed care, medical education, participatory medicine, social media, twitter

By Gregg A. Masters, MPH

The continued penetration of social media tools, platforms and derivatives into medicine in general and oncology in particular continues to make steady if not uneven headway into the workflow of medical groups, physician networks if not individual practices.

Still somewhat of a ‘show me the money’ value proposition, social media leverages widely accessible web-based and mobile technologies to create and share user-generated content in a collaborative and more often than not near real time social context. The ultimate promise is, that it’s effective uptake will enable new opportunities for physicians, other healthcare professionals and even certain ‘calcified institutions’ i.e., hospitals, to interact with patients in new and different ways.

In cancer care social media can serve as a platform for patient education (see: @Chemotopia) if not as an authoritative health messaging resource, where oncologists fulfill their role as trusted publishers if not de-facto ‘search nodes on the web’. Additionally many believe these emerging technologies can add to professional development, see @TumorBoard, knowledge sharing, and even where appropriate direct patient interaction, if key legal and privacy concerns can be addressed prospectively.

In the professional development department, the video below was shot on November 16 2012 at American Journal of Managed Care’s (AJMC) ‘Translating Evidence-Based Research Into Value-Based Decisions in Oncology’.

Featuring Dennis Scanlon, PhD, who addresses the ‘Importance of Payer/Provider Relationships’. Dr. Scanlon is Professor of Health Policy and Administration, The Pennsylvania State University, stresses: ‘it is very important to bridge the gap between providers and payers in oncology management’ as ‘there is a lot of variation in the cost and quality of care in oncology. The goal is to identify the appropriate payments for quality care.’

Get to Know ‘Chemotopia’

Tags

cancer, chemotherapy, chemotopia, evidence based medicine, integrative oncology, Just Oncology, medical education, oncology, social media, startUp health, twitter

By Gregg A. Masters, MPH

On the Wednesday, November 7th 2012 broadcast of
‘This Week in Oncology‘ we chatted with medical oncologist, integrative cancer care specialist, and ‘serial entrepreneur’ Steven Eisenberg, D.O., co-founder of StartUp Health Academy’s transformer entry ‘chemotopia‘aka @chemotopia on Twitter.

Disclosure: Dr. Eisenberg is a partner with Dr. Just in Cancer Care Associates for Research and Education (CCARE).

We spoke with Dr. Eisenberg about his most recent entrepreneurial interest known as ‘chemotopia’, where the tagline is:

getting through chemotherapy, together

To listen to the broadcast, click on the show logo below:

The Shell Answer Man

Tags

cancer, clinical trials, clinicaltrials, CME, digital media, evidence based medicine, health, Just Oncology, oncology, participatory medicine, social media, twitter

By Richard Just, MD

Over the past 37 years in practice, I’ve received thousands of requests from patients, family and friends to interpret results of clinical trials.  These requests have increased dramatically with the advent of the Internet.   Many of these reports involve poor trial design or are inappropriate for the patient under consideration.  Sometimes I’ve mumbled to myself “I feel like the Shell Answer Man”.  For those too young to remember, I’m referring to a Shell Oil Co. ad beginning in the 1960’s in which the ‘Shell Answer Man”, replete in his Shell gas station uniform, answered common questions about driving and the uses of gas and oil. He just memorized a script; sometimes I wish I had one.   

Over Labor Day weekend, while in Chicago for a family event, we turned on TV to catch up on the day’s news. As fate would have it, we stumbled upon a healthcare segment on the NBC affiliate.  The reporter was listing items individuals should consider in evaluating results of clinical trials.  It seemed to me that knowledge of these items would be very helpful to people who are not healthcare professionals; people who need some way to filter trials worth pursuing with their physicians.  The following are those questions:

1. Are the patients in the trial separated into groups, with one receiving the drug or regimen being tested (“Experimental Group”) while the other is treated with the agent(s) considered standard treatment (“Controls”)?  These groups are many times labeled “arms.”  The Control Arm may be a placebo if there is no known standard treatment.  This does not mean the patient receives no treatment at all.  These types of studies are considered the “gold standard” of clinical trials in that they involve large numbers of patients who are followed for long periods of time.  This increases the likelihood that resultant findings are valid.  The downside is they take a long time to complete and are very expensive (about $1 billion from start to finish).
2. What is the total number of patients entered into the trial?  As alluded to above, the more the better.  If one study includes 50 patients while another 350 (all other factors being equal), place more trust in the larger trial.
3. What is the length of the study? In other words, how long are the patients followed? Again, the longer the better.
4. Were the patients included in the trial representative of the proposed population to be studied?  For example, if the population to be studied involves pediatric patients, someone over 18 years of age should not be entered into the trial.
5. Who is funding the study? Pay attention here. If the study is paid for by the company who developed the experimental agent, how likely are they to give a completely unbiased report? Of course we want to assume that they will, but unfortunately, some won’t.  A government supported trial is more likely to report balanced findings than an industry funded one. The reporter added that patients should note what the authors say about their study, i.e., do they make overly optimistic claims for their treatments?  Most investigators add some type of cautionary note, like “the proposed treatment looks promising pending further studies.”  This disclaimer recognizes that no study is perfect.  In fact, there has been a marked increase in the number of studies initially reporting positive results that were retracted when similarly designed trials were subsequently negative.  The end result has been a delay in patients receiving appropriate treatments and a horrible waste of money.
6. I’m adding this one on my own. I’ve noticed that one of the most common mistakes people make is to search for clinical trials involving the wrong cancer, not realizing that we identify cancers by their organ-of-origin, not the organ where they spread (metastasize).  An example would be to collect articles about liver cancer instead of colon cancer that metastasized to liver.

As chairman of our hospital’s Investigational Review Committee, I and our members are in charge of reviewing proposed clinical trials conducted in our hospital district.  The above factors, as well as many others, are considered before studies are approved, denied or amendments recommended.  Consideration of the items discussed above could save everyone a lot of wasted time, and even lead to the retirement of the Shell Answer Man.

One More Monitor

Tags

digital health, doctors, George Sledge MD, medicine, Oncology Times, Per Chance to Dream, Quantified Self, science of sleep

By Richard Just, MD

At about 3:30 PM, I sat down in my family room, raised my feet onto an ottoman, and conked out until 5:00 PM with a copy of a medical journal in my lap.  My wife nudged me on her way out to meet a friend for dinner. When I’m sleepy, my first reflex is to check my continuous glucose monitor (CGM) for a high blood sugar level.  Nope.  95 and steady.  As they say on the beer commercial:  “It don’t get any better than this.”  I also wear (as in attached to my body, not my clothing) an insulin pump and a heart monitor. Neither of those could offer help in this situation. So I turned to my newest monitoring system: LARK (Editors Note: see Wired’s ‘How Lark Went From Idea to Apple Store in One Year‘).  According to the accompanying app on my iPhone, my “time asleep needs work”, meaning I should be averaging 8 hours of sleep per night, but I’m only getting 6.  LARK suggested I go to sleep earlier and at the same time each night.

My wife and I often drive up to L.A. for the day, a 300 mile round trip.  Lately, especially on our return trips to Escondido, I’ve been almost nodding off at the wheel.  A lot more serious than falling asleep in my family room!!  On these occasions, my wife is not so gentle in rousing me.  In June, she’d had enough and marched me down to the local Apple store to purchase a specialty device called LARK.  Because she is hearing impaired and doesn’t pick up many audible wake-up alarms, Dee Dee bought LARK primarily for the wristband which pulsates at a scheduled time.  While I also use this new silent alarm system, I am more interested in the objective data the accompanying app provides about my sleep patterns. Using this data, I’m alerted to possible corrective actions I can take to improve performance throughout the day.  I can also share this data wirelessly via Facebook or Twitter.

Coincidentally, in June, when I bought the device, Dr. George Sledge authored an article on sleep (“Perchance to Dream”, Oncology Times, June 25, 2012, pg 28), and a second article entitled “Decoding the Science of Sleep” appeared in the Wall Street Journal, August 4-5, 2012, pp 1-2.  Both document how common sleep disorders are. To illustrate, the annual number of prescriptions written for sleeping meds last year was about 60 million.  And studies have demonstrated that these pills don’t work.  Unfortunately, they can impair short-term memory so that people believe they slept better than they actually did.  So poor sleep habits “can also be a data problem” in that the medicated individual can’t really remember how well or poorly they slept.  Devices like LARK can collect this information for us, and supply analysis for possible solutions.

Before you can designate something as abnormal, it has to deviate from what is considered normal. A. Roger Ekirch, a Virginia Tech history professor, spent 20 years researching sleep and provides the seminal work defining “normal sleep”.  He found that, until about 200 years ago, our normal sleep pattern was divided into 2 phases:  the “first sleep” started just after sunset and lasted until just after midnight, when the person would wake up for about an hour, then fall back into the “second sleep” ending with the rising sun.  The time between the two episodes of sleep was spent reading, praying, contemplating dreams or having sex.  This normal sleep pattern was totally altered by Thomas Edison and the electric light.  The result is that about 20% of our general population has some type of sleep disorder.  We’ve become a “wired and tired” society.

Dr. Sledge estimates that 45% of cancer patients have insomnia.  Some are afraid to fall asleep as they might not wake up (“somniphobia”).  Sleep disorders tend to be intertwined with other problems, especially fatigue, depression, and pain, “making it hard to tease out cause and effect.”  For example, I saw a patient today with multiple myeloma who said his main complaint was fatigue.  On further questioning, he was taking longer naps during the day because he didn’t sleep well at night, sometimes taking an Ambien.  When this didn’t help, his primary care physician tried Lunesta, which didn’t work at all.  Turns out he wasn’t sleeping because his Velcade-induced neuropathy only bothered him at night.  Fortunately, this patient has a good memory and an attentive wife, who happens to be a nurse.  So we were able to figure out the problem without a device like LARK. But most situations are not this straight-forward, and data-driven solutions can be quite beneficial.

Why Cancer Research Requires Constant Vigilance

Tags

cancer care, clinical research, conflict of interest, evidence based medicine, oncology, publish or perish, scientific fiasco

By Richard Just, MD

One of my favorite writers on medical subjects is fellow ASCO colleague George W. Sledge, Jr., M.D.  I make it a point to read his essays in Oncology Times as they are always informative and well written.  One that caught my eye appeared on May 25, 2012 entitled “Fraud, Poor Ingredients, and Shortcuts in Cancer Research.”  Also in that issue is an article by Wendy S. Harpham, M.D. called “Scientific Fiasco.”  Whoa!!  Worth a second look. 

The three examples of fraud cited by Dr. Sledge all involved deliberate falsification of data and elaborate attempts to cover up deceit.  In fact, they could have been the basis for episodes of “Law and Order.”  Interestingly, these examples all occurred at respected academic institutions:  the University of Montreal in Canada, the University of Witwatersrand in Johannesburg, South Africa, and Duke University in North Carolina.  The most severe consequences to patients occurred in the South African example.  A toxic and sometimes lethal treatment (high dose chemotherapy + bone marrow or stem cell infusion) was given to women with breast cancer who should have received less toxic standard chemotherapy.  The toll in injuries and deaths that resulted was enormous.  The other two cases also impacted highly respected research institutions: the National Surgical Adjuvant Breast Project or NSABP was closed down for two years pending audit of all their trials, and Duke had to repay all grant money given to the researcher and suffered severe damage to its reputation.  Sad, but fraud and greed are an international phenomena, even in the field of cancer research.

As Dr. Sledge states:

My major concern with fraud is how long it takes us to catch on.

How can we prevent these atrocities from occurring? One would think that our peer-review process would be a good place to start. But as Dario Maestripieri explains in his work,  Games Primates Play, as cited in Dr. Harpham’s article, academic politics get in the way. Because of the need to “publish or perish”, some reviewers will review anonymously in order to trash the competition to give themselves an inside track. Obviously, when there is transparency and all reviewers are named, the review is less likely to be slanted and more likely to be honest and fair. Even more insidious and dangerous is when researchers and others in the industry of cancer research take shortcuts.  Basic sloppiness is responsible for the epidemic of retractions of published papers when initial reports cannot be validated in different labs or institutions.  The system encourages “getting published first rather than getting the science right.”  This type of behavior is unfortunately common. Again, it is sad that this takes place in an area that is supposed to be concentrating on the health and safety of human beings.

The issue of faulty cell cultures and contamination of tissue samples, which I’ve written about in previous blogs, result in poor ingredients.  An extensive article in Wired Magazine a few years back documents how antiquated our tissue storage techniques are, and that a high percentage of specimens are no longer suitable for research purposes when needed.  The entire field of Individualized or Personalized Oncology (indeed Medicine in general) depends on viable tissue specimens that may require storage for long periods of time in tissue banks.  A related issue is actual contamination of cell cultures by HeLa cells, highly malignant and rapidly growing cervical cancer cells.   All this leads to inaccurate results and slows progress in the field.

The committee at each institution responsible for overseeing the conduct of clinical and laboratory research is the Investigational Review Board (IRB) or Committee (IRC). This is where the peer review process for research occurs.  I have been Chairman of our IRC for the last 24 years.  Clinical Research has become a complex industry, both scientifically and administratively, during this time period.  As a result, our IRC’s workload and responsibilities have increased dramatically.  It’s easy to see where items can “fall through the cracks.”  Since our charge is to protect the safety of research patients, eternal vigilance is mandatory.

My Struggles With Our Electronic Health Records System

Tags

cancer, creative destruction of medicine, digital media, ehr, emr, eric topol, healthIT, oncology

By Richard Just, MD

My group purchased our Electronic Health Records system (EHR) about 5 years ago.  We had 4 clinical practice locations (soon to be 5 ½) with 1 administration office.  None of these sites are close to each other.  A major reason for purchasing an EHR was, and still is, to collect and analyze all data from our entire practice for the purpose of determining outcomes of our treatments. In other words, we wanted to know how our patients were doing in all of our offices, which treatments were working and which were not, and then use this information to refine and practice the best medicine we could. This was the promise of EHR.

And so my nightmare began.  Some of my patients define nightmare as something you didn’t wish for and it never seems to end.  Volumes could not fully describe my experiences.  I’ll just mention one “glitch”:  I noticed that some of my notes were disappearing into the ‘ethernet’ on a seemingly haphazard basis.  Sometimes I could locate them in another section of the chart; other times I wasn’t so fortunate.  Despite my staff spending weeks trying to find the defect, we had no success.  Our vendor monitored my work processes for two weeks.  Again, clueless.  To add insult to injury, I was told that I was the only one experiencing this problem which, of course, I took personally.  Turns out the problem occurred only when I started my note before my Medical Assistant entered vital signs.  So we had the explanation, but no fix.  As a result, I wait for my MA to enter her data, which frequently delays my ability to see patients on time.  Recently, we have added 2 physicians to our practice.  One of them asked me what he was doing incorrectly that caused some notes to disappear. This time I had the answer!! What’s more, I was now informed that it was a system wide problem for which there was still no fix.

When I was a kid, there was a TV show called the Naked City.  When episodes ended, the announcer said: “There are 8 million stories in the Naked City; this has been one of them.” I do know that my story is just one among many. But it’s still so annoying.  Because of the flawed design of this particular EHR system, we have been burdened with huge financial costs resulting from lost time, the need for extra IT support, and the hardening of my right carotid artery. I don’t need the added stress in this era of decreased reimbursements for providing clinical care and chemotherapeutic agents.  One of my partners has gone back to hiring a transcriptionist rather than using the EHR.  Another is chronically behind in his data entry.  To this date, we are not set up to pool and analyze our data for outcomes.  Soon, we are beginning the gut-wrenching process of converting to a new, and hopefully more user friendly, system.

A few weeks ago, I had the pleasure and honor to have a conversation with Eric Topol, M.D. on ‘this week in oncology‘ radio radio show. We were both intrigued by two articles that recently appeared in the New England Journal of Medicine on this subject.  The first, entitled “Escaping the EHR Trap—The Future of Health IT”, discredits the myth propagated by EHR vendors that health IT is different from industrial and consumer IT.  The authors suggest that vendors have alleged this to be fact “in order to protect their prices and market share and block new entrants.”

The second article is also quite enlightening:  “Unraveling the IT Productivity Paradox—Lessons for Health Care.”  In the 1970’s and 80’s, many industries adopted computers with the expectation that they would increase productivity.  To everyone’s surprise, digitization resulted in a significant reduction in efficiency. This was called the Productivity Paradox.  Subsequent research revealed that productivity attributed to computerization was underestimated due to defects in measurements, mismanagement of processes (such as summarized in the “glitch” in my system above), and poor usability.  Most systems, including mine, don’t have spell-checking capability.  Unbelievable!!

In chapter 7 of his must read, “The Creative Destruction of Medicine”, Dr. Topol discusses the benefits and challenges of Electronic Health Records and Health Information Technology in detail.  Despite the fact that digitization initially can be associated with an increase in errors, which doesn’t ease my pain, and many other challenges, he concludes:  “While some may consider the topic of electronic medical records prosaic, it should now be abundantly clear that their ultimate adoption and full interoperability will prove fundamental to the future of medicine.  Only via full electronic convergence can all the tools of digital medicine be in sync and immediately useful.  With the torrent of individualized data flow that is coming from whole genome sequencing, remote physiologic monitoring, and medical imaging, electronic information storage and processing will become more essential than even envisioned today.”

I have to agree with him. While this current transition period can be a frustrating, even painful experience, the alternative of a failed health care system is unacceptable.