Through the firestorm known as “healthcare reform” there are many, many hot button issues (myths?). There are misnomers like “death panels” and “socialized medicine” to the right, and ideas like “the glory of single-payer” and “no-need for tort reform” to the left. Amidst the far, far right and far, far left there are issues in the middle of the road that everyone agrees need to be addressed. One such issue: unnecessary testing.

Dr. WhiteCoat of WhiteCoat’s Call Room addresses the definition of “unnecessary testing.” He calls a spade a spade “…the term ‘unnecessary’ means that there is absolutely no likelihood that a test will find or exclude a disease…A majority of tests aren’t really ‘unnecessary,’ they just don’t show abnormalities very often.”

KevinMD of KevinMD.com goes into detail about why doctors order “routine” tests: the media, defensive medicine (another buzzword contender), reimbursement, and patient consumer-driven healthcare. Typically, “unnecessary testing” and “defensive medicine” go hand in hand. As a person without an MD, with considerable less insight into how doctors feel about malpractice, I find this statement incredibly enlightening: “If there were no-fault malpractice, health courts, or even caps (which I think is the least-effective solution), I would order less diagnostic tests. Period.”

Much like any topic there are two, three, four sides to even the simplest issue. But the fact remains that testing can be unnecessary or wasteful and it is costing Americans billions of dollars a year.

What do you think? Is unnecessary testing really “unnecessary?”

Should reform that would overhaul how the American Judicial System handles malpractice cases against doctors and hospitals be a part of the healthcare reform movement? Many argue yes. Philip K. Howard shares his opinion with the Wall Street Journal and explains why medical malpractice is off limits.

One of the talking points in the healthcare debate is the cost of it in the USA. With the American Medical Association estimating a savings of $200 Billion if defensive medicine is eliminated why isn’t medical malpractice at the forefront of the conversation?

Do you think that medical malpractice should be part of the conversation?

By: Bruce Cerullo, CEO

As the dutiful son of a proud, reasonably healthy, but aging 83 year old, I have had the pleasure of accompanying my Dad on many doctors’ visits. Yesterday, we visited an orthopedic surgeon's office. In the exam room with him I witnessed “CPOE” in action – Yikes!

First the set up: the doctor is a young, highly regarded surgeon at a top ranked practice affiliated with a leading Boston hospital. His practice has very recently deployed eClinincalWorks, which seamlessly interfaces Mckesson’s RIS System. Before the doctor came into the room, his Medical Assistant brought my father’s EMR up on the screen and loaded his CT Scan disc onto the desktop … everything was teed up for the doctor.

When the doctor entered the room, he consulted the main screen for an overview of my father’s record and began an examination of my Dad’s foot – so far so good – but then, the physician’s “meaningful use” began to deteriorate quickly.  As he returned to the computer to review past records, he had severe difficulty navigating the file and could not advance the images on the CT scan. Frustrated, he left the room and asked his assistant to “fix it.”  She sheepishly took stock of the situation, hit the escape key a couple of times,  and pronounced it "fixed." She then served as his computer navigator; a role that included entering his notes and orders for him! 

After the doctor left the room (under my gentle questioning) she admitted that a number of the doctors in the practice had been “too busy” to attend formal training and were doing their best to learn the application on-the-fly. The moral of this story: effective technology tools and their role in minimizing the inefficiencies of our healthcare system will only have a real impact if the clinicians truly embrace the change.  I know you all already know this … I just feel better having stated the obvious!

Have you had a similar experience?

By: Susan Sitarchuk, Healthcare Executive

While the majority of Health Facilities CIOs and Executives are scrambling to get information on accredited EMR systems and to get a handle on what is truly defined as “Meaningful Use” there exists another population of Healthcare Executives who are actually seeing the money. Who are these lucky people? These folks are the people who struggled endlessly prior to February 2009 and ARRA to get government sponsored funds: the Grant Department of Health Facilities and Teaching Hospitals.

In the old days, prior to February 2009, the grant writers would have to jump through large hoops to secure funding for the clinical studies and research that is so vital to healthcare. They were in charge of putting together volumes of documentation that were sent to the governing bodies that dole out federal grant monies. This process could take months to acquire all of the correct documentation to secure the most funding and while compiling all of the information needed, the health facilities may not have received any of the intended monies at the end of this road because the funding had run dry.

Well times have changed. These folks are now able to more easily write a grant request and go after the money made available by ARRA. Here is the nice part; they are actually getting the funding very quickly. There is a sum of grant money that was made available by the US government under the ARRA and each month the government website is updated with new grants. Through ARRA states have allotted grant money for particular research and studies.

The University of Pennsylvania (UPenn) has received more than $30 million in research funding from ARRA, awards that fund more than 100 studies in gene therapy, robotics, public education, neurological disorders, tobacco’s effect on health, and more. One such award is a $500,000 NSF grant to continue research into haptography, the science of capturing and recreating the feel of real surfaces. Not only does the field appeal to young scientists and encourages engineering careers, but the applications are widespread and include robotics assisted surgery, medical training and simulation, interactive museum exhibits, online shopping, and stroke rehabilitation. Other grants that UPenn has been awarded enable the purchase of high end instrumentation equipment to be used for biomedical research. Also, grants were awarded to supplemental research into the genome and for upgrades to core facilities to support biomedical and/or behavioral research.

This is just the tip of the iceberg; more funds are being released on a daily basis. Due to ARRA, 2010 should continue to deliver positive growth in the research arena. Healthcare facilities need to get organized and go after these funds. HIT departments must, regularly, pursue federally funded grant money as well as the monies that they will be eligible for when they have an accredited EMR system and can prove “meaningful use” of that product. With more money available for research grants and improvements in IT, the economy and our health have a better future.