Over recent months I’ve been exploring roles back in applied HIT, having been a CMIO (Medical Director of IT, now called “Chief Medical Informatics Officer”) in decidedly applied settings in the “olden days” a decade ago.

One common feature of the conversations I’ve had was that I’ve left these interviews with a sense of unease and annoyance, but was unclear why. It is only recently that I’ve been able to identify a common theme.

Imagine a seasoned neurosurgeon, interviewing for department chair, in the following interview scenario:

Candidate: I’m here interviewing for chair of the department of neurosurgery.

CIO: Well, you have an interesting background and have done many varied things. Were you aware that it’s important to be able to bring physicians into consensus? Tell us about how you intend to do that. Have you ever brought physicians into consensus?

IT project leader: How would you deal with pharma detail people? I don’t see that on your resume.

Finance: Billing is important. From your background, I’m not sure you understand billing. Tell us about your experience in that area.

Other doc: How would you go about treating meningitis? Can you actually do that? Have you ever done an LP?

While the scenario is absurdist, in effect I believe it summarizes metaphorically what I’ve been experiencing.

The hospital interviews I’ve been having are unlike anything I experienced in seeking clinical roles. They’ve even been a significant step down from some of the difficult ones I’ve had in pharma, where at least there is an understanding that holding an MD/Informatics title means the person comprehends something about biomedical research and computing.

In other words, I find that the designation of having studied Medical Informatics seems to confer no “fides” on a leadership role in applied Health IT (HIT) in hospitals. I’ve found myself interrogated about abilities and accomplishments in HIT as if “Medical Informatics” was being parsed as “Hsfapfwllerw”, i.e., meaningless, and as if past accomplishments were imagined or exaggerated. I find line items on a resume that state “led difficult HIT projects, managed staff, managed budgets” seem to mean tiny or are negated under the umbrella of the “Medical Informatics” title.

I find myself being asked frivolous questions on fundamental issues to which my reply really should be:

“Have you actually read my resume? Do you know what medical informatics is, and have you bothered to look before this interview?”

I’ve been preached to and patronized about HIT project issues by IT personnel and other non-clinical personnel, based upon what they seem to have read in their throwaway journals (e.g. “Advance for Health Information Executives”), as if I didn’t know anything about the area; as if IT staff were the clinical IT experts and I, an intern.

Another common finding is that materials I provide both pre- and post-interview on Medical Informatics (e.g., web links to my sites) are largely ignored, as I track my web sites by IP and can see from where they’re being read - or not.

Interviews of seasoned professionals in well-understood domains should not be like this. In my role interviewing doctoral-level faculty candidates for my college, we never, for example, asked them or challenged them if they understood basic tenets of information/library science, as if they were undergraduates. To do so would have been both unthinkable and alienating. Instead, we sought to have candidates tell us about their specific areas of expertise and how that could fit our needs. The assumption was that by being invited, we understood they were a competent professional.

Yet in medical informatics I’ve started to dread interviews, due to the absurdist scenario above, the need to present myself as someone who “gets it” regarding HIT, and the need to provide remedial education in an interview setting to confused people.

The weaknesses in societal understanding of the term “Medical Informatics”, therefore, are unhelpful to people who’ve expended the time and treasure acquiring the credentials and who wish to work in applied HIT.

This phenomenon impairs the capability of the Medical Informatics profession to contribute to and steer HIT in the service of medicine, and to help healthcare organizations avoid commonplace, costly errors regarding clinical IT projects they can ill afford.

I am assuming this phenomenon is not just part of a bigger phenomenon of dumbing-down in healthcare, of cost-cutting and institutionalized mediocrity.

This really needs to change.

– SS

[Source : Health Care Renewal]

In the Washington Post, E J Dionne wrote about the recent collapse of the sub-prime mortgage market, and near collapse of at least one prominent investment banking firm, but what he wrote was also highly relevant to how US health care currently operates (I realize that some of Dionne’s views might have an ideological slant, but I believe the point goes beyond the usual left/right dichotomy).

Never do I want to hear again from my conservative friends about how brilliant capitalists are, how much they deserve their seven-figure salaries and how government should keep its hands off the private economy.

The Wall Street titans have turned into a bunch of welfare clients. They are desperate to be bailed out by government from their own incompetence, and from the deregulatory regime for which they lobbied so hard. They have lost “confidence” in each other, you see, because none of these oh-so-wise captains of the universe have any idea what kinds of devalued securities sit in one another’s portfolios.

So they’ve stopped investing. The biggest, most respected investment firms threaten to come crashing down.

But if this near meltdown of capitalism doesn’t encourage a lot of people to question the principles they have carried in their heads for the past three decades or so, nothing will.

We’d already learned the hard way — in the crash of 1929 and the Depression that followed — that capitalism is quite capable of running off the rails. Franklin Roosevelt’s New Deal was a response to the failure of the geniuses of finance (and their defenders in the economics profession) to realize what was happening or to mend it in time.

As the economist John Kenneth Galbraith noted of the era leading up to the Depression, “The threat to men of great dignity, privilege and pretense is not from the radicals they revile; it is from accepting their own myth. Exposure to reality remains the nemesis of the great — a tiny understood thing.”

But in the enthusiasm for deregulation that took root in the late 1970s, flowered in the Reagan era and reached its apogee in the second Bush years, we forgot the lesson that government needs to keep a careful watch on what capitalists do. Of course, some deregulation can be salutary, and the market system is, on balance, a wondrous instrument — when it works. But the free market is just that: an instrument, not a principle.

In the last 20 years, for-profit health care corporations seem to have turned their leaders into imperial CEOs. Their organizational cultures have been turned into cults of personality extolling the wisdom of their fearless leaders. Such brilliant leaders of course deserved equally brilliant compensation. So there have been plenty of CEOs of for-profit health care corporations who have had seven-figure-plus compensation. But sometimes, that compensation seemed not very proportional to their competence. (Remember the examples of the “brilliant” former CEO of UnitedHealth, or the former CEO of Pfizer Inc.)

Furthermore, the leaders of not-for-profit health care organizations have also become objects of personality cults, which suggested that they too deserved lavish, often seven-figure salaries and to live the high life at the expense of organizations whose missions are ostensibly to treat disease and reduce suffering, and/or to train students and pursue science. (See our latest example of the leaders of the University of Texas Southwestern Medical Center.)

We’ve often suggested that leaders who are more focused on their own wealth, power, and privilege might not be good at improving patient care, or advancing academic medicine.

So let us quote Galbraith again, and remember what he said applies well to leaders of health care organizations.

The threat to men of great dignity, privilege and pretense is not from the radicals they revile; it is from accepting their own myth. Exposure to reality remains the nemesis of the great — a tiny understood thing.

Far too many leaders of health care have accepted their own myth. Thus it is likely that all too soon, some important part of the health care system will come crashing down like Bear Stearns unless health care professionals and patients can shred these myths in time.

A massive hat tip to Dr Peter Rost on the Question Authority Blog.

[Source : Health Care Renewal]

We’d posted a while back about how a not-for-profit, say supported academic medical center, University of Texas- Southwestern Medical Center, had created an “A list” of local notables who were to be given special treatment, including enhanced access to physicians. This seemed to imply some slippage from the institution’s mission (see post here). It turned out that the practice may not be very special, but neither is is universal (see this post).

The local television station that uncovered this practice, “CBS 11,” has been keeping an eye on the medical center. Late last year it found out its top officials had quite a taste for pricey wine.

Top say officials at the University of Texas Southwestern Medical Center in Dallas spent tens of thousands of dollars in donations on luxury wines from prestigious New York wine merchants.

A CBS 11 News investigation of charges to the university’s credit cards found that President, Dr. Kern Wildenthal, and his right hand assistant, Vice President, Cyndi Bassel, spent more than $125,000 on wine.

A UT Southwestern spokesman states the say healthcare institution bought the wine with money from unrestricted donations and not tax funds. John Walls explained the wine expenses in a written statement, ‘The buys from New York dealers were for hard-to-find wines not readily available in local retail shops, which were especially appropriate for individual commemorative gifts and special recognition events.’

The TV station’s reporters also found that the Medical Center was using restricted donated funds to wine and dine its top executives, even though the funds were meant for very different purposes.

Upon his death in 1986, [Jesse] Brittain left his life savings of more than $390,000 to UT Southwestern. Brittain’s endowment agreement specified that the money was to be used ‘for the sole purpose of enhancing the business operation of UT Southwestern giving priority to the professional development of personnel in the business operation, including training courses, books, seminars, etc.’

Instead,

CBS 11’s hidden camera was there to record how the say university has been using money from the Jesse Brittain Memorial Fund.

The family of the late donor states the money was intended to help train employees and not for what CBS 11’s investigation found.

The undercover video captured an annual holiday party held for a choose group of the university’s business administrators.

The state officials gathered in a luxurious penthouse dining room on the University’s North Campus. It is a rarified atmosphere with a half million dollar collection of sleek tables designed by the internationally recognized Spanish architect Santiago Calatrava and a astonishing night vista of twinkling lights on the Dallas skyline.

A white jacketed chef carved slices of herb crusted sirloin from a $450 side of beef. A waiter strolled through the party serving risotto crab cakes that cost $316 and artichoke hearts filled with goat cheese that cost $316.

Tables of silver serving trays filled with specialty appetizers were decorated with huge gingerbread houses.

Partygoers bellied up to an open bar where more than $1000 worth of drinks were served.

The celebration that CBS 11 found in full swing is one of three annual holiday celebrations that have been paid for with more than $15,000 from the Jesse Brittain Memorial Fund.

In general,

CBS 11’s review of financial records obtained under the Public Information Act indicates that more than $40,000 was spent on meals and refreshments which were paid for with money from Brittain’s Memorial Fund over the past two years.

Finally, CBS 11 documented how the Medical Center CEO was living high on the hog supported by tax-exempt donations.

Dr. Kern Wildenthal, the President of the University of Texas Southwestern Medical Center in Dallas, spent tens of thousands of donors’ dollars on European trips, meals at five star restaurants, parties and pricey gifts, according to CBS 11’s review of the state university’s records.

CBS 11 uncovered more than $500,000 in expenses charged over the past two years to credit cards issued to Wildenthal and Cynthia Bassel, UTSW’s Executive Vice President for External Relations. Financial records obtained under the Public Information Act indicate that most of the expenses were paid for with money that was donated to the medical institution.

The Southwestern Medical Foundation, the university’s fundraising arm, paid for the bulk of the credit card expenses including:
–$533 for a donor dinner at a five star restaurant at the Hotel Meurice in Paris, France, for Wildenthal, his wife Margaret, British opera singer Robert Lloyd and his spouse and Andre Dunstetter, a Parisian social figure with ties to Dallas.
–$783 for Wildenthal’s two most recent annual memberships in Mosimann’s Dining Club, an exclusive restaurant in London.
–$459 for collectible Woodland Eagle dinnerware, including a platter and four mugs from Crow’s Nest Trading Company, for two donors in April of 2007.
–$13,000 for tulip arrangements sent to donors for Valentine’s Day over the past two years. A note on the 2007 order teaches the florist to deliver a half-dozen of the arrangements to Wildenthal’s home.
etc, etc, etc

Also,

Both Wildenthal and Bassel have charged thousands of dollars to the credit cards for memberships in social and civic organizations. CBS 11’s review found that donors’ money from the Southwestern Medical Foundation was used to pay for Wildenthal’s 2007 membership dues in the Dallas Symphony ($3500); Dallas Museum of Art ($5000); Nasher Sculpture Garden ($5000); British North American Committee ($6000); Dallas Women’s Club ($850); and the SMU Town and Gown Club ($140).

As we noted earlier, the UT Southwestern mission statement is [with italics added for emphasis]:

* To improve health care in our community, Texas, our nation, and the world through innovation and education.
* To educate the next generation of leaders in patient care, biomedical science and disease prevention.
* To conduct high-impact, internationally recognized research.
* To deliver patient care that brings UT Southwestern’s scientific advances to the bedside — focusing on quality, safety and service.

Somehow, I do not see anything about fancy wines, opulent dinners, and luxurious trips for the top leaders.

Once again, it appears that the leaders of huge health care organizations fancy themselves different from you and me. They seem to feel entitled to membership in the power elite, to lead the high life (and not the version from a Miller beer commercial) while leading organizations that are supposed to focus instead on the community and to bring quality care to all patients’ bedsides. I have no objection to good pay for people who work hard on behalf of the mission. But it is unseemly for leaders of not-for-profit health care organizations to live like minor nobility while so many health care needs remain unmet.

By the way, it might not be that what the University of Texas - Southwestern Medical Center was doing is uncommon. In a summary of the case just published in the Nonprofit Quarterly, Rick Cohen wrote,

As studies from the General Record-keeping Office and the Congressional Research Service show, these nonprofit indulgences are frequently standard operating practice. The hospital has dismissed all criticisms by pointing out that UT Southwestern’s fundraising and expenditure patterns are right in line with nonprofit hospital practices nationally, including the proportion and nature of expenditures on fundraising including gifts for donors. They further suggest that donors to the UT Southwestern foundation fundraising arm know full well that their donations—classified as unrestricted—will be used for expenses that aren’t particularly focused on medical care or research, but for the CEO’s club memberships, upscale dinners and gifts for donors and bigwigs, and flower arrangements sent to the CEO’s home. Therein might be the real issue, not that UT Southwestern is behaving out of the norm, but that it is exactly within the mainstream of huge nonprofit hospitals. And no one seems all that put out, because this is what’s expected of large corporate institutions, for-profit, nonprofit, hospitals, universities, corporations, it really doesn’t matter all that much.

So it would surprise me not at all to find out that many executives of many academic medical centers and teaching hospitals are similarly living the high life. This, of course, goes along with many discussions on Health Care Renewal of health care leaders who seem to put their pocketbooks ahead of their patients. If this is as widespread as Rick Cohen and I think it is, why are we wondering why health care is increasingly costly and inaccessible, while its quality declines, and health care professionals get ever more disgruntled?

[Source : Health Care Renewal]

Schizophrenia known as a mental disorder which have a strong genetic component. A Queen’s academic, part of an international team which has discovered a gene that increases the danger of developing schizophrenia found that the discovery of the gene, MEGF10, could be a step in the right direction towards helping those affected.

Dr O’Neill and his colleagues from the Department of Psychiatry at Queen’s stated, the further finding helps piece together the complex picture underlying risk to schizophrenia and offers the hope of more successful interventions in the future. They’re now trying to comprehend how difficulties with the developing brain can compromise important brain systems leading to the bewildering and distressful symptoms of schizophrenia.

Adapted from materials provided by Queen’s University, Belfast.

[Source : General Health]

Do you have a thought about a relation or link between canine and human cancers? Well, I dont. But researchers from University of Minnesota veterinarian Jaime Modiano do. They’re studying the similarities and genetic links between canine and human cancers to help fight the disease.

It was revealed in ScienceDaily that beside having friendship and companionship, humans and dogs also share the same genetic basis for certain types of cancer.

Matthew Breen, Ph.D., stated, many forms of human cancer are associated with specific alterations to the number or structure of chromosomes and the genes they contain. They developed reagents to show that the same applies to dog cancers, and that the specific genome reorganization which occurs in comparable human and canine cancers shares a common basis.

It was found that the genetic changes that occur in dogs diagnosed with certain cancers of the blood and bone marrow, including chronic myelogenous leukemia (CML), Burkitt’s lymphoma (BL), and chronic lymphocytic leukemia (CLL), are virtually identical to genetic abnormalities in humans diagnosed with the same cancers.

(Credit: University of Minnesota, Academic Health Center)

[Source : General Health]