Pharmacists

Is Healthcare IT Ready for its Big Coming Out Party?

In 2001, when my colleagues and I ranked nearly 100 patient safety practices on the strength of their supporting evidence (for an AHRQ report), healthcare IT didn’t make the top 25. We took a lot of heat for, as one prominent patient safety advocate chided me, “slowing down the momentum.” Some called us Luddites.Although we hated to be skunks at the IT party, we felt that the facts spoke for themselves. While decent computerized provider order entry (CPOE) systems did catch significant numbers of prescribing errors, we found no studies documenting improved hard outcomes (death, morbidity). More concerning, virtually all the research touting the benefits of HIT was conducted on a handful of home-grown systems (most notably, by David Bates’s superb group at Brigham and Women’s Hospital), leaving us concerned about the paucity of evidence that a vendor-developed system airlifted into a hospital would make the world a better place.Since…

“This American Life” on Why the Healthcare System is Out of Control

If you can spare 2 hours, do yourself a favor by listening to the two-part healthcare series on NPR's extraordinary show, This American Life. By using examples that are memorable for their simplicity and lack of hyperbole, the series (the episodes are here and here) does a superb job illustrating how we got into the predicament we’re in, and how hard it is will be to extricate ourselves from it. Although the dominant theme mirrors that of the Expensive Lunch Club I discussed in July, the vignettes and interviews bring the problems to life: what we can learn about healthcare insurance by examining the emerging market in pet insurance (yes, you too can treat your pet hedgehog with antipsychotics); the acne medicine whose generic version costs $500 less than the brand version (and the cat-and-mouse games Big Pharma plays to get patients to favor the latter); the accidental nature of…

Welcoming UCSF’s New Chancellor, My Friend Sue Desmond-Hellmann

Reunions are fun, but they can make you feel old. I remember strolling around Penn’s campus for my 25th reunion, and seeing several buildings named for people I knew in college. Wow, I thought, that’s when you know you’re ancient.Another way is when the chancellor of your university – the senior official at UCSF – was your chief resident. Despite the exaggerated creakiness that I'm feeling in my bones, I’m thrilled that a few hours ago, University of California President Mark Yudof named Sue Desmond-Hellmann to be UCSF’s next chancellor, succeeding Nobel Prize winner Mike Bishop, who is retiring.Sue was a resident, chief resident, heme-onc fellow, and junior faculty member at UCSF in the 1980s and early 90s. After a brief stint at Bristol-Myers Squibb, in 1995 she joined Genentech, the South San Francisco biotech giant founded in the 70s by UCSF’s Herb Boyer and venture capitalist Robert Swanson. Although…

Are We Mature Enough to Make Use of Comparative Effectiveness Research?

Thanks to White House budget director Peter Orszag, a Dartmouth Atlas aficionado, $1.1 billion found its way into the stimulus piñata for “comparative effectiveness” research. Terrific, but – to paraphrase Jack Nicholson – can we handle the truth?In other words, are we mature enough to use comparative effectiveness data to make tough decisions about what we will and won’t pay for? I worry that we’re not. First, a bit of background. Our healthcare system, despite easily being the world’s most expensive, produces (by all objective measures) relatively poor quality care. Work begun 3 decades ago by Dartmouth’s Jack Wennberg and augmented more recently by Elliott Fisher has made a point sound-bitey enough for even legislators to understand: cost and quality vary markedly from region to region, variations that cannot be explained by clinical evidence and do not appear to be related to healthcare outcomes. In other words, plotting a 2x2…

A Shout Out to Adam Singer, Physician Entrepreneur of the Year

Modern Physician just named Adam Singer, the founder of IPC-The Hospitalist Company, its first annual Physician Entrepreneur of the Year. Adam and I don’t always see eye to eye, but I want to congratulate him and highlight some of his contributions.When the hospitalist field launched in the mid-1990s, Adam was there – I recall seeing him at virtually every hospitalist-related meeting during the early years. He struck me as a bit awkward – maybe a tad insecure – but he was brimming with passion and a near-religious fervor for the hospitalist concept. He had just started his company, whose business was to organize hospitalist programs and place them in hospitals, first in So Cal, and later in other regions. In essence, IPC was really the first “rent” (vs. buy) hospitalist solution, and it quickly found a market niche.Adam’s vision was unique and deeply held. He frequently scolded me for what…
12345...