Wednesday, February 25, 2009

Who will be the next Secretary of Health and Human Services?


Speculation is swirling about whom our next HHS Secretary will be. President Obama is expected to make an announcement very soon. Reliable sources tell me that it might be Governor Kathleen Sebelius. Below is information on Governor Sebelius. The information below was taken from various sources found on the Internet.

Pledging independent leadership to move Kansas forward, in 2003 Kathleen Sebelius became the 44th Governor of the State of Kansas. Governor Sebelius was reelected to a second term in 2006.
At the heart of Governor Sebelius’ administration is a commitment to growing the Kansas economy and creating jobs; ensuring every Kansas child receives a quality education; protecting Kansas families and communities; improving access to quality, affordable health care; and taking advantage of the state’s renewable energy assets. In 2005, Time magazine named her one of the nation’s top five governors.
Since the rising cost of health care is a threat to families and businesses, the Governor is working to ensure Kansans have access to quality and affordable health care. She’s also proposed providing health insurance to every uninsured Kansas child from birth to age five in order to give these children a healthy start on life.
Governor Sebelius serves on the National Governors Association’s Executive Committee and is co-chair of the National Governors Association’s initiative, Securing a Clean Energy Future. Sebelius is the immediate past chair of the Education Commission of the States and as past chair of the Democratic Governors Association, she currently serves on the DGA Executive Committee.
Married to husband, Gary, a federal magistrate judge, for 34 years, they have two sons: Ned and John. Both Sebelius boys are products of the Topeka public school system, pre-kindergarten through high school. Ned is a law student, and John is a graduate of the Rhode Island School of Design.
Prior to becoming Governor, Sebelius served for eight years as a representative in the Kansas Legislature and eight years as Insurance Commissioner. She is credited with bringing the agency out from under the influence of the insurance industry. She refused to take campaign contributions from insurers and blocked the proposed merger of Blue Cross Blue Shield of Kansas, the state's largest health insurer, with an Indiana-based company. The decision by Sebelius marked the first time the corporation had been rebuffed in its acquisition attempts.
While she was Kansas Insurance Commissioner, she chaired the NAIC’s Health Insurance Committee and was President of the NAIC in 2001. In those capacities, she played the lead role in developing NAIC policies around health insurance. For example, she was active nationally in the implementation of the Health Insurance Portability and Accountability Act and helped draft a proposed national bill of rights for patients. She also worked with multiple state commissioners with a variety of markets to develop NAIC recommendations around the issues.
Healthy Kansas is one of Governor Sebelius’ initiatives. This initiative is designed to contain runaway health care costs, streamline the health care system, and make health insurance and prescription drugs more affordable for thousands of children, working parents, and small businesses. Throughout 2005, a group of Kansans representing multiple disciplines and organizations came together to identify and adopt health priorities that would improve the health of Kansans. Healthy Kansans 2010 builds on a nationwide health promotion and disease prevention agenda called Healthy People 2010. This process resulted in a set of recommendations for change. Progress would be measured by 10 Leading Health Indicators: Physical Activity, Overweight and Obesity, Tobacco Use, Substance Abuse, Responsible Sexual Behavior, Mental Health, Injury and Violence, Environmental Quality, Immunization, and Access to Health Care.
Healthy Kansans 2010 also identified three issues impacting multiple health indicators:
1) Reducing and eliminating health disease disparities among segments of the population that need to improve the most. These disparities stem from many factors, including race/ethnicity, age, gender, geography, social and economic status, and disability status.
2) System interventions to address social determinants of health, which include income, education, and social supports.
3) Early disease prevention, risk identification and intervention for women, children and adolescents.
As part of the Healthy Kansas Initiative, Governor Sebelius formed the Governor’s Council on Fitness. This council encourages increased physical activity, healthy diets and tobacco use prevention by sharing information with Kansans and partnering with businesses, schools and individuals to promote healthy lifestyles.
Since Sebelius became governor, the state has expanded cancer screenings, allowed more residents to keep their health insurance up to 18 months after leaving their jobs and granted income tax deductions to help some lower their insurance costs. It also has increased funding for "safety net" clinics and expanded state medical and dental coverage for pregnant women.

April, 2003 – Require adequate insurance coverage for agritourism; should either clarify legislatively that these businesses are covered, or require insurance companies to offer adequate coverage
January, 2004 – Obtain better prices for prescription and services; created Governor’s Office of Health Planning and Finance to work on plans to obtain better prices for prescription drugs and other health care services by leveraging buying power in the marketplace
June, 2004 – Cutting Medicaid will increase number of uninsured; warned that Federal Government did not plan to extend one-time increase in Medicaid funding and would force states to cut budget; complained about slow payments.
November, 2006 – Urged Legislature to insure all Kansas children from birth to age five; did not pass
November, 2006 – Supported I-Save-RX: Low cost prescriptions from Canada and Europe; Kansan now participates in this initiative
January, 2008 – First step of overhaul: health care to 10 million children; Democratic response to 2008 State of the Union address; “stronger as a nation when our people have access to the highest-quality, most-affordable health care. When our businesses can compete in the global marketplace without the burden of rising health care costs here at home. . . A large majority of the Congress is ready to provide health care to 10 million American children, as a first step in overhauling our health care system.”

For Immediate Release
October 22, 2008
Nicole Corcoran, Press Secretary
785.368.8500
Health care reform
The following is a column by Governor Kathleen Sebelius:
Last month, we received some discouraging but not surprising news about health care coverage in our state. There are now more Kansans without health insurance than at any other time this decade. Nearly 340,000 Kansans do not have health insurance, including 58,000 children. This is the third year in a row that our uninsured numbers have increased.
The Legislature formed the Kansas Health Policy Authority and asked for a plan for comprehensive health care reform. Last year they received that plan, which included input from Kansas employers, families and health care providers, and would have insured far more Kansans. Not only would more Kansans have access to basic health coverage, but the plan included a number of proposals to lower costs for those Kansans with health insurance.
I endorsed the plan; as did many Republicans and Democrats, and those legislators deserve our respect and gratitude. But the leadership and the majority failed to move forward, so we made no progress. Costs continue to rise and more Kansas employers and families are dropping coverage.
We cannot wait any longer. The 2009 Legislature must get to work on health care reform. There is no more time to waste. All Kansans deserve access to quality health care, and they’re counting on the Legislature. The time for real leadership and action on health care is now.
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Sunday, February 15, 2009

A Couple of Items Regarding the American Recovery and Reinvestment Act 2009

Included in the American Recovery and Reinvestment Act, H.R. 1 are two committees that will deal with health care information technology standards and policy. The two committees are the HIT Policy Committee and the HIT Standards Committee.

The HIT Policy Committee is referred to in the Bill as a committee with broad responsibilities. The Bill outlines the committee membership as follows:

IN GENERAL.—The National Coordinator shall provide leadership in the establishment and operations of the HIT Policy Committee.

MEMBERSHIP.—The HIT Policy Committee shall be composed of members to be appointed as follows:

  1. One member shall be appointed by the Secretary
  2. One member shall be appointed by the Secretary of Veterans Affairs who shall represent the Department of Veterans Affairs
  3. One member shall be appointed by the Secretary of Defense who shall represent the Department of Defense
  4. One member shall be appointed by the Majority Leader of the Senate
  5. One member shall be appointed by the Minority Leader of the Senate
  6. One member shall be appointed by the Speaker of the House of Representatives
  7. One member shall be appointed by the Minority Leader of the House of Representatives
  8. Eleven members shall be appointed by the Comptroller General of the United States, of whom: three members shall represent patients or consumers; one member shall represent health care providers; one member shall be from a labor organization representing health care workers; one member shall have expertise in privacy and security; one member shall have expertise in improving the health of vulnerable populations;one member shall represent health plans or other third party payers; one member shall represent information technology vendors; one member shall represent purchasers or employers; and one member shall have expertise in health care quality measurement and reporting
  9. Chairperson and Vice Chairperson - The HIT Policy Committee shall designate one member to serve as the chairperson and one member to serve as the vice chairperson of the Policy Committee. http://thomas.loc.gov/home/approp/app09.html#h1
The HIT Standards Committee

First, a little history on the HIT Standards Committee. The following text was written by John Glaser and posted on www.histalk2.com.

In 2004, the Federal Department of Health and Human Services (HHS) established a series of organizations and initiatives in an effort to further the adoption of interoperable electronic health records (EHRs).

The Healthcare Information Technology Standards Panel (HITSP), the Certification Commission for Healthcare Information Technology (CCHIT), and the Office of the National Coordinator for Healthcare Information Technology (ONC) were established. Demonstrations of aspects of a National Health Information Network (NHIN) were conducted, analyses of privacy regulations were undertaken, and assessments of EHR adoption were performed.

Overseeing all of these activities and organizations was a Federal Advisory Committee, the American Health Information Community (AHIC). You can learn more about all of the above at www.hhs.gov/healthit. AHIC was chaired by the Secretary of Health and Human Services and the committee’s membership was composed of individuals from diverse sectors of healthcare and various HHS agencies and Federal departments.

AHIC was set up to transition, at the end of 2008, to a successor organization. During 2008, the Brookings Institution managed an extensive series of meetings and analyses which involved hundreds of individuals from across healthcare, which designed the successor. This successor was to be a public-private organization and continue the work of the AHIC.

The resulting successor organization is the National eHealth Collaborative (NeHC). You can learn more about NeHC at www.nationalehealth.org.

NeHC is focused on advancing the adoption and effective use of interoperable EHRs. To do that, the NeHC will:

  • Use Value Cases to define opportunities to establish interoperability standards. The Value Case approach modifies the AHIC Use Case by performing more upfront analyses to ensure that the standards have a compelling value proposition and are likely to be adopted quickly by the market. In addition, the Value Case approach requires greater participation by healthcare organizations and seeks external funding of the work. It is highly likely that the Value Cases will be broader than transaction standards; Value Cases could also be policy and architecture frameworks and best practices. HITSP and CCHIT would continue their respective roles of interoperability specification development and product certification.
  • Develop preliminary strategies and approaches for governing the emerging National Health Information Network.
  • Identify barriers to the adoption of interoperable EHRs and commission work designed to overcome those barriers. This work might center on financial incentives, privacy approaches and procedures, data use agreements, and implementation practices.

NeHC will focus on “the ground.” In other words, while NeHC will work with government and industry on policy, its core orientation will be practical – how do we help those of us who are trying implement these systems overcome barriers and have a greater likelihood of improving care?

NeHC is a membership organization. Its members are organizations that have an interest in interoperable EHRs. In the next couple of months, information will be made available that outlines the membership application process and dues structure.

You all should check out the NeHC web site for new developments and announcements. You can also contact me (jglaser@partners.org) or Laura Miller, NeHC Interim Executive Director of NeHC (lmiller@ahicsuccessor.org) with questions and comments.

The Bill outlines a lot information about the HIT Standards Committee but the following is very interesting.

MEMBERSHIP AND OPERATIONS.—

IN GENERAL.—The National Coordinator shall provide leadership in the establishment and operations of the HIT Standards Committee.

MEMBERSHIP.—The membership of the HIT Standards Committee shall at least reflect providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information.

BROAD PARTICIPATION.—There is broad participation in the HIT Standards Committee by a variety of public and private stakeholders, either through membership in the Committee or through an

other means.

and later in the bill...

NATIONAL EHEALTH COLLABORATIVE.—Nothing in sections 3002 or 3003 or this subsection shall be construed as prohibiting the National eHealth Collaborative from modifying its charter, duties, membership, and any other structure or function required to be consistent with the requirements of a voluntary consensus standards body so as to allow the Secretary to recognize the National eHealth Collaborative as the HIT Standards Committee.

Monday, February 9, 2009

What is it like to be a patient?

I have some simple surgery (is there such a thing?) scheduled for Wednesday of this week. I thought I would start a list of my general observations about the experience. Overall, this experience is a great reminder of what 2,000+ patients and families experience in our health system every single day. My comments below are in no way meant to be negative but rather my objective observations of the experience.
The physician suggests surgery to remove bone spurs and repair some simple problems in my shoulder. I am given contact information for the surgery scheduler in the physician's office. Three phone calls later and I am booked for surgery. Pre-op is scheduled for 3 days prior to surgery in the physician's office. A separate pre-op appointment is needed with the hospital outpatient surgery department and I am given that number to call to make the appointment. I end up booking both pre-op appointments on the same day.
Arrival at the physician's office. The front desk person does not want to copy any of my cards and does not have me fill out any additional forms. The physician representative calls me back and reviews all details of the surgery. This person did an excellent job including giving me temporary markings to put on my left shoulder that say "wrong" so that I do not have a wrong site surgery incident. I leave this appointment to go to the hospital for the hospital pre-op appointment.
I found the hospital department with out much problem and check-in. The front desk representatives are very nice. Soon a lady calls me back to complete the registration details. A copy of my insurance card and license is made even though I know these are in our document imaging system. I wonder why they are being scanned again but at the same time I appreciate that our A/R days are low for all of our hospitals. The representative wanted to look up my information in the computer manually for some reason even thought I was all geeked up to put my palm on the palm vein scanner http://www.fujitsu.com/global/about/rd/200506palm-vein.html and watch my name appear on the registration screen (we just implemented it in all of our facilities). Once the representative was done I went back to wait for the lab work. A few minutes later another person calls me back for a blood draw. My name was not verified although I suspect the person saw my name badge when I walked in and used that to verify. Once the blood draw was done I was walked to another area to wait in the hall to speak with a nurse. Once in the office I met with a nurse who took my history and explained to me the procedure and what to expect. Everything went very well.
I am disappointed at how fragmented this process feels for a simple surgery and I will be thinking about how we can improve this for our patients. I can't help but think of the hip replacement patient or the back surgery patient who must deal with all of this while not feeling well and it makes me wish that it could be so much simpler. I am a healthy person with a mild problems so I take it all in stride. More to come....

23andme.com

I decided to have my DNA genotyped by 23andme.com. Having this done took a leap of faith since I am somewhat concerned about privacy and how this data may be used against me in the future. In the end, I decided to go for it so that I could have a more precise picture of my future health. For $399.00 23andme.com will genotype my DNA and provide a report online in 8-10 weeks. The report will provide me with information on health traits, ancestry and the blinded data will be used for research by 23andme.com.
I have looked at example data on the site and I really like what I see. I am looking forward to knowing more about my health and different types of illnesses that I may encounter. Because of a strong family history of cancer and heart disease I already have concerns about cancer sneaking up on me when I least suspect it. I am hopeful that this will provide me with a little more information. For example, one report gives the likelihood of prostate cancer if certain criteria are met. That is the kind of information I can use! http://www.23andme.com/
As of today 23andme.com offers information on 90 diseases, conditions and traits. As new research comes forward they will update my record with new information.
Twenty-six clinical reports are available in addition to 75 research studies. Here is the list and information directly from the web site.
Clinical Reports give you information about conditions and traits for which there are genetic associations supported by multiple, large, peer-reviewed studies. Those associations must also have a substantial influence on a person's chances of developing the disease or having the trait. Because these associations are widely regarded as reliable, we use them to develop quantitative estimates and definitive explanations of what they mean for you.
Age-related Macular Degeneration
Alcohol Flush Reaction
Bitter Taste Perception
Bloom's Syndrome
Celiac Disease
Crohn's Disease
Cystic Fibrosis (Delta F508 mutation)
Earwax Type
Eye Color
G6PD Deficiency
Glycogen Storage Disease Type 1a
Hemochromatosis
Lactose Intolerance
Malaria Resistance (Duffy Antigen)
Muscle Performance
Non-ABO Blood Groups
Norovirus Resistance
Parkinson's Disease
Prostate Cancer
Psoriasis
Resistance to HIV/AIDS
Rheumatoid Arthritis
Sickle Cell Anemia & Malaria Resistance
Type 1 Diabetes
Type 2 Diabetes
Venous Thromboembolism