A case study of Romania’s healthcare system

Question: what do you do if your child gets sick on a weekend in Romania?
Answer: nothing; not an effing thing, not unless you want to deal with Romania’s state health system.

Sophie got sick over the weekend. We initially thought it was a mild case of heat stroke. Now we think it’s enterocolitis.

We don’t frequent state-run hospitals in Romania, because the doctors and nurses are more often than not undertrained and uncaring unless you bribe them, and the facilities are incredibly dirty and overrun with filthy, smelly “citizens” — you know, the kind of “citizens” who don’t contribute a cent toward the very services they overrun.

When she started to complain of a headache and tummy ache and started to go limp in Ligia’s arms, we panicked. We thought, okay, let’s hop in the car and drive to the private Polisano hospital in Sibiu, which is where we typically go on the rare occasions when we need medical care.

An aside: we don’t go to the state-run hospital in Medias, which is where we live, because it’s packed full of the same medical staff I mentioned above and is also full of the same “citizens” in its waiting rooms. The last and only time we tried using the emergency room at the hospital in Medias, Sophie could have literally died for lack of care and concern on the part of the staff, who were more concerned with the “citizens” than with tax-paying, hard-working people like us. But hey, the SMURD helicopters can fly low right over our houses to ferry the dirty dipshits to the emergency rooms, waking us up and scaring our children at night, because why not, dirty dipshits are more important than tax-paying, law-abiding, decent people.

Back to Polisano. Turned out they were closed on weekends. What kind of a hospital is closed on weekends?! So there were no private, paying alternatives for people like us on a weekend. We were pointed in the direction of the state-run emergency room.

We walked in. It was chock full of dirty, smelly “citizens”, some of them yelling at the nurses. Some dipshit was yelling about suing the hospital, so everyone could hear him. The door to the treatment room got slammed into his face by one of the nurses (good on her). There was grime everywhere in the public areas, even on the walls. There weren’t enough chairs. “People” were standing up, emanating the unmistakable stenches of unwashed sweat, layers of it, that had been alternately drying up and getting wet again on them for days on end. NO way we were staying there. We walked out with nowhere to go.

Thankfully, Sophie started feeling better. We took a walk through Sibiu’s historic district with her. We held her in our arms. When we got back to the car, she started complaining again about aches. We were at a loss, with nowhere to go.

Sophie’s usual pediatrician doesn’t answer her phone on weekends. Most of the doctors in Romania don’t answer their phone on weekends, as if diseases and accidents take a break on the weekends as well. A pediatrician in Medias even yelled at me when I called her on a Saturday, told me not to bother her and go to the emergency room.

I got in touch with my dad, who is a doctor — albeit not a pediatrician, but a psychiatrist and a damn good one if I might add. He lives in another part of the country, so he couldn’t see Sophie personally, but judging from her symptoms, he eliminated heat stroke and pointed us toward the likely possibility of enterocolitis, probably contracted at the kindergarten. We picked up some furazolidone for her from the only pharmacy in town open 24 hours and drove home.

As a last reminder of how shitty the healthcare system is in Romania, the hallway leading up to the pharmacy stank to high heaven of a filthy mix of old perspiration and urine. I complained to the pharmacist, who apologized and said about half an hour before me, a gypsy woman had come in for something and left the pungent odour behind her. The pharmacist had opened all of the windows to air out the stench, but it was stubbornly clinging to the space.

Conclusion: For f***sake, don’t get sick on weekends in Romania. Better yet, just don’t get sick in Romania, period, end of story.

Romanian doctors play hooky at Buenos Aires conference

My parents just got back from a big, worldwide conference in Buenos Aires, Argentina — the 15th World Congress of Psychiatry. My dad, who is a devoted psychiatrist, went there to learn new things, like most doctors who go to conferences.

Unfortunately, all but five of the entire group of Romanian doctors (150 in total) who registered for the conference decided to play hooky. This was after their travel, hotel stay and meals were paid for by European pharmaceutical companies, who flew them out there so they could stay up to date on the latest research.

One of the event staff confided to my father that the Romanian doctors couldn’t be bothered to even pick up their badges, which is something that only takes a few minutes. Instead, they all went on a sightseeing trip through Patagonia and were absent for the entire duration of the conference.

In case you’re not sure why this matters, you may want to read through my review of the Romanian healthcare system.

Healthcare in Romania

 

There are two options for the person requiring care: the public healthcare system, financed by the government, where one is supposed to be cared for without cost if they hold medical insurance, and the private healthcare system, which is not really a system but is made up of different, unrelated private clinics or hospitals, where one must pay all expenses out of pocket. Let’s look at each system in more detail.

Public healthcare

I believe there are three main problems plaguing public healthcare in Romania:

  1. Widespread corruption at all levels of care. Bribes must be paid to hospital directors, managers, doctors and nurses, and sometimes even to hospital guards, if you are to get any competent care other than a daily temperature and blood pressure check until you check out or expire, whichever comes first.
  2. Incompetent personnel, due to:
    1. An inefficient medical education system, staffed with teachers and professors who care more about furthering their own careers, brown-nosing and getting bribes than teaching students how to be proper nurses and doctors.
    2. An unwillingness on the part of most students and medical personnel to put in the effort to acquire the knowledge they need to do their jobs right.
  3. Old facilities and equipment. Hospitals and clinics lack the funds to maintain the infrastructure properly, so all of them are run-down, cold in winter, hot in the summers, with drafty rooms and hallways where you’re likely to catch pneumonia, with bathrooms that have leaky faucets and leaky toilets, mostly left uncleaned, smelly, wet and old, with metal beds that date way back from the 1st or 2nd world war (I’m not kidding about this), and with mattresses that have seen more than their fair share of human bodies and bodily fluids. When it comes to equipment, it’s mostly non-existent, other than basic X-ray machines.

Sure, there are exceptions. There are some doctors and nurses who don’t ask for bribes. And there are some medical personnel who are competent at their jobs — they know how to do them and take the time and effort to put their knowledge to good use. But if you think the two groups contain the same people, you are probably mistaken. It’s usually the doctors who are the most competent that demand the bigger bribes, though it could be that a really good doctor or nurse may also be the one who doesn’t ask for or accept bribes. There’s no way to tell, really. It’s like taking a potshot in the dark. You’ll go to get some care and may end up with a butcher or a blundering fool who only makes things worse, and you may also end up paying him or her plenty of money for the shoddy treatment.

On some level, I understand why the corruption exists. Salaries for government-paid doctors and nurses are very low — janitors at profitable private businesses usually make more money than doctors in government hospitals — but that’s still no excuse for the endemic corruption. While salaries are low, medical personnel have also gotten used to asking for money from each and every patient, to the point where they expect it for the littlest thing and won’t help you if you don’t pay. There’s a ridiculous, infuriating sense of entitlement among most, if not all of them. Somehow they’ve gotten to think you owe them money simply for looking at you. That’s not right.

If only they’d take the time to study more, to get better at their craft, I, along with the millions of Romanians who visit hospitals, would feel better about paying extra to get care, but most are ignorant of any new developments in their fields. They only know enough to get by on routine matters. As soon as there are complications, they’ll take your money for a consultation, then tell you to go see this other doctor, who’ll ask for his share, then send you along to another, and so on and so forth until you’ve seen seven, eight, nine, ten doctors, have spent a month’s or two months’ salary on bribes, and you’re still no closer to getting treated right or cured. They’ll all nod their head, promise to help, take your money, run their tests, then scratch their heads and say they’re not sure what’s going on, that you’ll need to come see them again in a little while, etc., while happily fleecing you.

When it comes to government nurses, they won’t administer the injections or infusions or obey the doctors’ orders if you don’t slip them a bill, or some coffee, or chocolate, or whatever. It has to be something a little more expensive than just some candy or a trinket, and let me tell, when you’re being seen by four or five nurses and you need to make sure each of them gets something, it gets expensive. It’s so sad to visit hospitals and see all the old people on small pensions walk about with sad looks on their faces, mostly ignored by the nurses who are supposed to care for them, simply because they can’t afford to bribe them.

Private healthcare

There is hope when it comes to Romanian healthcare, and as is usual in a free enterprise system, it’s found in the private arena, where there are financial incentives for those willing to take some risks and make some investments in buildings, medical equipment and qualified personnel.

There are private clinics and hospitals, completely separate and unrelated to the government, where you can get competent care if you have the money to pay for it. Truth be told, it may end up costing you less than government healthcare if you add up all the extra costs involved with bribing government personnel.

Only the best doctors and nurses get hired in the private clinics and hospitals, are paid good salaries, are forbidden from taking bribes, and these facilities are equipped with the latest devices needed for proper patient care. There are entire hospitals and sanatoriums placed in beautiful locations in the mountains, where you can go to spend a few weeks to relax and get allopathic or natural, holistic treatments. There’s an entire gamut of options available to those willing to pay out of pocket.

For example, let’s say you need to run a whole battery of tests to see how your body is doing. You can go to the local government hospital, see and bribe a doctor to get some tests, then go to five or six different labs inside the hospital to run those tests, bribe your way through each place, then come back to the doctor in a few days to give him or her more money to look at the test results and tell you what’s going on. Or you can check into a private clinic, where for a fixed cost, you will spend a few days in a clean, private room with proper heating and cooling, pick your food from a menu, have your meals served to you, be able to take showers in a clean bathroom, be seen by caring, competent doctors and nurses, and get accurate test results interpreted properly. That’s the difference.

I should mention that private doctors’ offices aren’t the same thing as privately-run clinics and hospitals. Many government doctors also keep private offices, and will actually force people who come to see them in hospitals to go to their private offices and pay out of pocket to get the same care they could get for free in hospitals, but the care patients get there is just as bad as inside hospitals, and the facilities are usually just as unhygienic and inefficient. No, you must seek out professional private clinics and hospitals if you want to get the serious care I mentioned above.

Possible solutions

I think you know by now which option I would pick if I were to get sick in Romania, and for good reason. That’s not to say public healthcare can’t be fixed. In recent years, there’s been a serious push against corruption in Romania, at all levels of government, not just in healthcare, driven by the EU, but they haven’t made much headway other than talking about it and putting up posters in government agencies. Much more needs to be done, and it needs to start first with better salaries for medical personnel, probably double or triple what they are now.

Corruption in Romania is a very serious problem, one that requires an organization with teeth, one that can and does take immediate action against infractors, and where the identity of the person reporting incidents of corruption is kept top secret. Sadly, the system is still stacked against those willing to report it. Think for a moment what happens to someone who wishes to report a doctor who asks for money. First, they won’t get the treatment they need, and they may have an urgent medical problem, and then, if their identity is leaked, word about them spreads like wildfire, and no medical personnel at that hospital will want to treat them — and it may be the only government hospital or clinic in town. So people usually shut up and pay up, because they want to get on with their lives, not cause problems for themselves and for others.

Until the problems of corruption and salaries and public healthcare infrastructure get resolved, I would encourage people to use private healthcare options, if they can afford it. The more people use private healthcare, the more affordable and accessible it will get over time, and the more incentive there will be for the government to fix public healthcare.

Cigna increases premiums while CEO gets more pay

Our medical insurance policy is with Cigna. We’re on the Open Access Plus plan. After I renewed my Cigna policy recently, I got our new insurance cards, and noticed that the premiums and copays increased as follows:

  • PCP Visit ($20 vs $15)
  • Specialist ($40 vs $30)
  • Hospital ER ($100 vs $50)
  • Urgent Care ($50 vs $25)
  • Rx ($10/25/50 vs $10/20/45)

Those are some pretty hefty increases, particular for items 2-4 above, so I thought I’d have a look at Cigna’s executive compensation packages, to see if they’re tightening the belt there as well.

Their CEO is H. Edward Hanway. Here’s what he makes [source]:

  • Current annual compensation: $30.16 million
  • 5-year compensation: $120.51 million
  • His performance vs. pay rank is 162/175, which means he’s the equivalent of a D/F student

In 2006, two years ago, here’s what he was making [source]:

  • Annual compensation: $28.82 million
  • 5-year compensation: $78.31 million
  • Performance vs. pay rank: 166/189, which was slightly better than what he’s averaging now

So what we’ve got here is an overpaid CEO that isn’t pulling his weight, but still paying himself gobs of money off our backs. God knows how much the other executive officers are making, all while we, the customers, get charged more for our premiums and copays. Talk about a rotten deal.

I don’t think that’s fair at all.

Happy Birthday Tataie

It’s my grandfather’s birthday today. He died just a couple of weeks ago after a painful struggle with mesothelioma, a form of cancer caused by asbestos exposure.

He’d been coughing for a few years. It was a persistent cough, but it wasn’t a severe cough. He coughed here and there, and especially after he came into a cooler room after working outside, in his beloved garden. Then things got worse. He kept getting cold-like symptoms and coughing more. When doctors in Romania examined him, they discovered water in one of his lungs. They started drawing it out with syringes regularly, liters at a time. A lesion of sorts developed at the site where they kept inserting the needle. A biopsy of the lesion revealed nothing. Things didn’t improve.

My parents hoped that the Florida weather would do him good, so they brought him to the States. He loved the weather, but didn’t get better. They thought US medical care would be better than Romanian medical care, so they put him in a hospital here. Doctors literally paraded by his bedside by the tens, specialist after specialist, all of them clueless. Oh, let’s try this, let’s try that, blah, blah, blah — that’s how the story usually goes. X-rays and CT scans and urine and lab tests every day, and still they couldn’t figure things out.

Finally they decided to open him up and see what was going on. That’s when they discovered he had mesothelioma, with a few “localized” tumors in his right lung. But they still couldn’t figure out what to do about the water accumulation, so they proposed to insert talcum powder between the lung walls, in the hope of sealing that chamber and stopping the leaks (that’s apparently a standard procedure for this sort of thing).

So they opened him up again and inserted the powder. Water still accumulated, this time more slowly, but it still happened. Then he developed difficulty swallowing. They stuck tubes with cameras down his throat. More CT scans, more X-rays, and still no idea why. Well, let’s enlarge his esophagus and cardiac sphincter (the opening from the esophagus to the stomach.) That might help… Well, it didn’t. He still had trouble swallowing.

They didn’t know what else to do for him, so they released him from the hospital. The bill came to well over $100,000, and my grandfather was no better than before. He was worse, and now he had to contend with pain from the surgery and the other procedures done on him while in the hospital.

My mother had to blend everything into a soupy puree before feeding him, and still he had trouble swallowing. He withered and dried out and lost tens of pounds. He was hardly recognizable, but his spirit was still well, and he hoped he’d get better. That was the hardest part, to see him trying to eat and unable to swallow, then leave the table with a horribly sad look on his face.

We knew he wouldn’t last long like that, so we convinced him to return to Romania, where at least he could die in his own home, if it were to come to that. Once he got there, my aunt, who took care of him, put him on IV fluids. He got a little better. We decided to try seeing some specialists there in Romania, so she took him to the hospitals in Sibiu and Timisoara.

If you don’t know how the healthcare system works in Romania, I’ll tell you. It’s based on heavy bribes. If you don’t bribe the doctors and nurses, no one cares about you. No one even looks at you, and you’re treated like scum. If you have the money to give them, you actually get somewhat decent service, depending on how much you give. You can’t lay the blame entirely on the medical personnel for this practice though. Doctors’ salaries are horribly tiny, smaller than the salaries of some janitors at well-to-do companies. So they need cash infusions from the patients in order to be able to live properly. But the way they go about it is disgusting to me. And there’s no telling when they’ll make up stuff about your condition just so they can get more money out of you. They’ll even do extra procedures (if they’re unethical people) so you’ll pay them more.

Once in the hospital, they slipped a feeding tube through his nose and into his stomach. In Sibiu, they opened him up again and discovered some lesions on his esophagus, and some on his stomach. They said he needed his esophagus replaced, but that they couldn’t do the procedure, and that he needed to be sent to Timisoara. We believe the doctor who operated on him at Sibiu twisted his stomach or intestines around and caused a severe blockage in his GI tract, because his digestion and regularity were never the same after that.

In Timisoara, the specialist who was to replace his esophagus with a silicone stent bragged to high heaven that he was the only one doing the procedure in Romania and in the entire Western Europe. If that sounds phony to you, don’t worry, you’re right. He just wanted to make sure he got enough money for the job. He ended up operating on my grandfather, but replaced less of the esophagus that he’d originally said. We’re not sure why. Things went completely downhill from there.

My grandfather never recovered from that operation. His situation got worse and worse every day. Now he couldn’t digest his food at all, even the soups he was fed through his tube. He coughed up blood and fluids of various colors. He got thinner and more dehydrated every day. My aunt put him back on IV fluids, but they didn’t help. He was in horrible pain, throughout the day and night. He moaned in agony. He couldn’t sleep. When he did manage to sleep, he would writhe and cry out in anguish. He was dying.

Four days before he died, he asked my aunt to make the preparations for his burial. He knew it and he was ready. He asked her to let him go, to stop trying to keep him alive. She couldn’t stop caring for him, but she knew it was going to end anyway. He looked forward to joining my grandmother in the grave next to hers.

And then he died in the evening. I got the call from my mother. She was crying. I couldn’t cry. I knew what he’d been through, and wanted him to get the rest and peace he so badly needed. I was angry with everything that had happened to him, and still am. Why did he have to die in such pain? Why did he have to encounter the utmost morons in his quest for decent medical care? Why did he have to suffer so much?

We don’t know when he got exposed to asbestos. It wasn’t uncommon in communist Romania to get exposed to dangerous conditions or materials. He worked at the same factory all his life, and got promoted to chief technical engineer from a humble line worker. He came up with various inventions and improvements during his career, and was even decorated by Romania’s dictator, Nicolae Ceausescu, for his contributions. I’m not saying this because I care about Ceausescu, who was a horrible man, but I care about my grandfather and about his life’s work, and was glad to see him get recognized.

For me, my grandfather’s suffering serves to underline how little medical science really knows about the human body, and how horribly few things they can do to cure people. In spite of all our technology and advances and drugs, when it comes to treating disease, our options are very limited, and very primitive. We can:

  • Mask the symptoms by treating them with drugs
  • Cut into people and butcher them with plain knives or sear them with electric knives, then sew them up with string
  • Poison them with radiation therapy and chemotherapy

I remember my frustration with this while in medical school, and perhaps it had something to do, subconsciously, with my leaving it to return to IT work. At least in IT you can find out what’s really wrong and can fix it either through code or hardware replacements.

What my grandfather’s death also showed (amply) is how many idiots there are in the healthcare system. My God, we have so many doctors out there that can’t diagnose their way out of a paper bag, and they run test after test and try this and that and still can’t figure out what’s wrong. I’m fortunate enough to know there are good doctors (although they’re few and far between) who know how to diagnose with much less information at their fingertips, because I’ve met some of them.

If all these retards can graduate medical school and can pass the boards, then clearly medical education isn’t doing its part in weeding them out. I had plenty of them in my class in med school, too. They were the ones who got by very nicely by rote memorization. Worked great, until you asked them to analyze something — then they looked at you like a hen looks at a newspaper.

Another one of my beliefs was reinforced: that the overwhelming majority of nurses are lazy asses that don’t care at all about their patients. I’m sorry if that offends you, but that’s the truth. I know this because I saw they way they treated my grandfather, and I saw the way they treated other patients over the years.

All nurses seem to want is more money and more benefits for as little work as humanly possible. Oh sure, they put in a lot of “hours”, but most of those hours are spent socializing at the nursing station, not by the patient’s bedside. What’s unfortunate is that the market is tilted so much in their favor right now (and will continue to be for the next several years) that nothing significant can be done about it. There’s a nursing shortage, and that means we’re going to have mediocre, good-for-nothing nurses in all of our hospitals until supply meets demand, and hospitals can start to weed out the non-performers.

I tell you, the nursing profession will not emerge unscathed from this. The stink caused by these bad nurses will taint the good ones, too. The good ones are out there, I’ve met some of them, and when I say they’re good, I honestly mean it. They’re great, and they care, and they know a lot, but they’re few and far between, and they’re mostly in academia.

Coming back to my grandfather, I think of my grandmother’s death two years ago, also in June. A week or so after her burial, it was my grandfather’s birthday, and I remember him celebrating it with us, his family, but without his beloved wife. The sorrow was evident on his face, even through his smiles, and there was nothing any of us could do for him but to try and cheer him up.

Now, he’s resting in the grave, and it’s his own birthday. There’s no birthday celebration now. Just pain and a feeling of irreplaceable loss.

Rest in peace, tataie. You taught me how to build and fix things and work in the garden, and how to use tools and paint and be the man I am today. You were the first man I looked up to, the first one that made me want to learn how to shave. I saw you do your best, every day, to care for and protect your family. You never spoke much, but you did much. You were loved, and are loved. Rest in peace.

Google Health is a good thing

When it launched a few weeks ago, Google Health received fairly lackluster reviews. Privacy issues and lack of features were the main complaints. Well, I’m here to tell you those initial views are wrong.

Even if you’re a long-time reader of my site, you may not know what qualifies me to make that statement, so let me tell you a bit about myself.

My background

A few years ago, I was Director of Health Information Systems at a South Florida hospital, where I implemented an electronic medical records system. My job was fairly unique, because I not only wrote the policies and procedures for the system and oversaw its implementation, but I also rolled up my sleeves and built the various screens and forms that made it up. I, along with my staff, also built and maintained the servers and databases that housed it.

As far as my education is concerned, I hold a Master’s Degree in Health Services Administration (basically, hospital administration). I was also admitted to two medical schools. I ended up attending one for almost a year until I realized being a doctor wasn’t for me, and withdrew.

For plenty of years, I’ve been a patient of various doctors and hospitals, as have most, if not all of you, for one reason or another.

Furthermore, my father is a doctor: a psychiatrist. He has a private practice, and also holds a staff job at a hospital. My mother handles his records and files his claims with the insurance companies, using an electronic medical records system. I get to hear plenty of stories about insurance companies, billing ordeals, hospitals and the like.

So you see, I’ve seen what’s involved with medical records and access to said records from pretty much all sides of the equation. Again, I say to you, Google Health is a good thing, and I hope you now find me qualified to make that statement.

The benefit of aggregation

Just why is it such a good thing? Because I wish I could show you your medical records — or rather, their various pieces — but I can’t. That’s because they exist in fragments, on paper and inside computer hard drives, spread around in locked medical records facilities or in your doctors’ offices, all over the place. If you endeavored to assemble your complete medical history, from birth until the present time, I dare say you’d have a very difficult time getting together all of the pieces of paper that make it up — and it might not even be possible. That’s not to mention the cost involved in putting it together.

A few of the problems with healthcare data sharing

Do you know what my doctor’s office charges me per page? 65 cents, plus a 15 cent service fee. For a 32 year old male (that’s me) it would take a lot of pages (provided I could get a hold of all of them) and a lot of money to put my medical record together.

The sad part is that this is MY medical information we’re talking about. It’s information that health services workers obtained from MY body. It’s MY life and MY record, yet I can’t have access to it unless I fill in a special form at every doctor’s office I’ve ever visited, and pay for the privilege. Is that fair? NO. Can something be done about it? YES, and so far, Google Health is the only service I’ve seen that is trying to pull together all of the various pieces that make up my medical record, for my benefit and no one else’s. Sure, the system is in its infancy, and there’s a lot of work to be done to get it up to speed, but that’s not Google’s fault.

I’ve been inside the healthcare system, remember? I know how things work. I know how slowly they work, to put it mildly. I know how much resistance to change is inherent in the system. Just to get medical staff to use an electronic medical records system is still a huge deal. The idea of giving the patient access to the records, even if it involves no effort on the part of the medical staff (but it does, as you’ll see shortly) is yet another big leap.

Let’s also not forget to consider that medical records systems are monsters. Each is built in its own way. There are certain lax standards in place. Certain pieces of information need to be collected on specific forms. The documentation needs to meet certain coding standards as well, or the hospitals or doctors’ offices or pharmacies won’t get reimbursed. There are also certain standards for data sharing between systems, and the newer systems are designed a little better than older ones.

Yet the innards of most medical health systems are ugly, nasty places. If you took the time to look at the tables and field names and views and other such “glamorous” bits inside the databases that store the data, you’d not only find huge variations, but you’d also find that some systems still use archaic, legacy databases that need special software called middleware just so you can take a peek inside them, or form basic data links between them and newer systems. It’s a bewildering patchwork of data, and somehow it all needs to work together to achieve this goal of data sharing.

The government is sort of, kind of, pushing for data sharing. There’s NHIN and the RHIOs. There are people out there who want to see this happen and are working toward it. Unfortunately, they’re bumping up against financial and other barriers every day. Not only are they poorly funded, but most healthcare organizations either do not want or cannot assign more money to either getting good record systems or improving their existing ones to allow data sharing.

Add to this gloriously optimistic mix the lack of educated data management decisions made in various places — you know the kind of decisions that bring in crappy systems that cost lots of money, so now people have to use them just because they were bought — and you have a true mess.

Oh, let’s also not forget HIPAA, the acronym that no one can properly spell out: Health Insurance Portability and Accountability Act. The significant words here are Insurance and Accountability. That’s government-speak for “CYA, health organizations, or else!” There’s not much Portability involved with HIPAA. In most places, HIPAA compliance is reduced to signing a small sticker assigned to a medical records folder, then promptly forgetting that you did so. Your records will still be unavailable to you unless you pay to get them. Portability my foot…

Benefits trump privacy concerns

Alright, so if you haven’t fallen asleep by now, I think you’ve gotten a good overview of what’s out there, and of what’s involved when you want to put together a system like Google Health, whose aim is to pull together all the disparate bits of information that you want to pull together about yourself. Personally, I do not have privacy concerns when it comes to Google Health. There are more interesting things you could find about me by rummaging through my email archives than you could if you went through my health records. If I’m going to trust them with my email, then I have no problems trusting them with my health information, especially if they’re going to help me keep it all together.

Not sure if you’ve used Google Analytics (it’s a stats tool for websites). Not only is it incredibly detailed, but it’s also free, and it makes it incredibly easy to share that information with others — should you want to do it. You simply type in someone’s email address in there, and you grant them reader or admin privileges to your stats accounts. Instantly, they can examine your stats. Should you prefer not to do that, you can quickly export your stats data in PDF or spreadsheet format, so you can attach it to an email or print it out, and share the information that way.

I envision Google Health working the same way. Once you’ve got your information together, you can quickly grant a new doctor access to your record, so they can look at all your medical history or lab results. You’ll be able to easily print out immunization records for your children, or just email them to their school so they can enroll in classes. A system like this is priceless in my opinion, because it’ll make it easy to keep track of one’s health information. Remember, it’s YOUR information, and it should NOT stay locked away in some hospital’s records room somewhere. You should have ready access to it at any time.

Notice I said “whose aim is to pull together all the disparate bits of information you WANT to pull together” a couple of paragraphs above. That’s because you can readily delete any conditions, medications or procedures you’d rather keep completely private from Google Health. Should you import certain things into it that you don’t feel safe storing online, just delete that specific thing, and keep only the information you’d be comfortable sharing with others. It’s easy; try it and see.

Lots of work has already been done

Another concern voiced by others is that there isn’t much to do with Google Health at the moment — there isn’t much functionality, they say. I disagree with this as well. Knowing how hard it is to get health systems talking to each others, and knowing how hard it is to forge the partnerships that allow data sharing to occur, I appreciate the significant efforts that went on behind the scenes at Google Health to bring about the ability to import medical data from the current 8 systems (Beth Israel Deaconess, Cleveland Clinic, Longs, Medco, CVS MinuteClinic, Quest, RxAmerica and Walgreens).

What’s important to consider is that Google needed to have the infrastructure in place (servers, databases) ready to receive all of the data from these systems. That means Google Health is ready to grow as more partnerships are forged with more health systems.

In order to illustrate how hard it is to get other companies to share data with Google Health, and why it’s important to get their staff on board with this new development in medical records maintenance, I want to tell you about my experience linking Quest Diagnostics with Google Health.

Quest is one of the companies listed at Google Health as having the ability to export/share their data with my Google Health account. What’s needed is a PIN, a last name and a date of birth. The latter two are easy. The PIN is the hard part. While the Quest Diagnostics websites has a page dedicated to Google Health, where they describe the various benefits and how to get started, they ask people to contact their doctors in order to obtain a PIN. I tried doing that. My doctor knew nothing about it. Apparently it’s not the same PIN given to me when I had my blood drawn — by the way, that one didn’t work on Quest’s own phone system when I wanted to check my lab results that way…

Quest Diagnostics lists various phone numbers on their site, including a number for the local office where I went to get my bloodwork done, but all of the phone numbers lead to automated phone systems that have no human contact whatsoever. So Quest makes it nearly impossible to get in touch with a human employee and get the PIN. Several days later, in spite of the fact that I’ve written to them using a web form they provided, I still don’t have my PIN and can’t import my Quest Diagnostics lab results into my Google Health account.

Updated 5/27/08: Make sure to read Jack’s comment below, where he explains why things have to work this way with Quest — for now at least.

That is just one example of how maddening it is to try and interact with healthcare organizations, so let me tell you, it’s a real feat that Google managed to get eight of them to sign up for data sharing with Google Health. It’s also a real computer engineering feat to write the code needed to interact with all those various systems. I’m sure Google is working on more data sharing alliances as I write this, so Google Health will soon prove itself even more useful.

More work lies ahead

I do hope that Google is in it for the long run though, because they’ll need to lead data sharing advocacy efforts for the next decade or so in order to truly get the word out to patients, healthcare organizations and providers about the benefits of data sharing and Google Health.

For now, Google Health is a great starting point, with the infrastructure already in place and ready to receive more data. I’m sure that as the system grows, Google will build more reporting and data export capabilities from Google Health to various formats like PDF, as mentioned several paragraphs above, and then the system will really begin to shine. I can’t stress enough what a good thing this is, because just like with web search, it puts our own medical information at our fingertips, and that’s an invaluable benefit for all.

Join me for a short screencast where I show you Google Health. You can download it below.

Download Google Health Screencast

(6 min 28 sec, 720p HD, MOV, 39.8MB)

A doctor's view on "free lunches" and politicians

The following open letter from Dr. Sanford Siegel, President of the Chesapeake Urology Associates, to Rep. Henry Waxman (R-CA), was pointed out to me this morning. I asked Dr. Siegel’s permission to post it in its entirety on ComeAcross, and he agreed. I’m struck by how true this letter rings. My father is a doctor. He works hard, seven days a week. He wakes up at 5 in the morning and usually works till 10 or 11 at night. Whatever “free lunches” he gets when he goes to get CMEs (Continuing Medical Education) or to attend conferences and seminars in order to become a better doctor are well deserved. On the other hand, I’m not so sure how well deserved the salaries of our politicians really are, considering their work ethic, isolation from public sentiment, and openness to lobbyists. But then again, the tactic of distracting the public has been employed by politicians for ages, so this should be no surprise. Read Dr. Siegel’s letter, it’s an eye opener!

Dear Mr. Representative,

On Saturday July 29, 2006, there was an article on the front page of The Baltimore Sun entitled “Medical Salesmen Prescribe Lunches.” This article describes how the pharmaceutical representatives use free lunches to gain access to Doctors. In this article, you are quoted to say, “It’s obvious that drug companies provide these free lunches so their sales reps can get the Doctor’s ear and influence the prescribing practice. That’s not the way it should be done. Physicians should get their information from peer review and objective sources.” I am a physician, and we do get our information from peer reviewed journals and continuous medical education meetings. We are required to have 50 hours a year of continuing medical education. The reps simply supply valuable prescribing information about the use of the
drugs and their benefits.

Instead of insinuating impropriety on the part of Doctors and Pharmaceutical reps, maybe you should look into how your Congress functions. You are a member of the most abusive Congress in history. You are a member of Congress that will only work 76 days this entire year. That is the lowest number of days in history. They call this Congress, affectionately, the “Tuesday to Thursday Club,” as the Representatives come to work on Tuesday and leave Thursday afternoon. The lowest salary paid to a Congressman is $165,200/year. If you think I am misinformed, please refer to the ABC news report done on Saturday July 29th. They did the piece on, “Are we getting our monies worth?” Obviously, we are not.

The average salary for a Pediatrician is less than $100,000/year. They work 7-days-a- week, 48 to 50 weeks a year. They have not had a pay raise in 15 years. When was your last pay raise? We get “free” lunches from these Pharma Reps so we can learn about new drugs, their benefit to our patients, and where they will be harmful. Most of us will take 10-15 minutes a day for lunch, and most days we do not get lunch. We cannot see them during office time. Our days start at 7-8 in the morning and don’t end like other people’s work days. When we finish office hours, we go to the Hospital to see patients, and it does not end there, either. We then can go home and make phone calls to patients for an hour. We do this every day, 5-6 days a week. That is a far cry from your 76 days a year.

Your quote makes reference to the influence they have on us to use their drugs. Are you so naive to believe that a turkey wrap or a piece of dried out chicken parmesan will make us use a drug which we do not feel will be beneficial to our patients? Why is it legal for the airlines to give frequent flier miles for inducement to people to use that airline or for the restaurants who provide these Doctor lunches to have “frequent buyer” programs where “each dollar spent earns points that can be exchanged for movie tickets, gift certificates to Home Depot or Nordstrom or an ‘executive spa treatment,'” for the Reps who buy them? Should I believe that the junkets to Scotland for your colleagues to play golf, the lavish dinners they throw for members of Congress, the free airplane tickets or Super Bowl tickets, etc., do not influence you and your votes? Are you getting your information from, as you said, those “objective sources, the highly paid lobbyist?” How can you be so self-righteous? I am so insulted by your comments.

Like most Congressmen, Doctors are honest, hard-working people and dedicated to the people they serve. We do not abuse or take advantage of the system. Tell me what you would do without us? There may be a few bad apples, but the medical care in the United States is second to none. Is it made worse by these lunches? We have been hammered with 40% to 50% cuts in our reimbursement over the last 15 years. The Doctors share of the health care pie has shrunk from 30% to 8%. Overhead continues to soar. Healthcare insurance rates to my employees rose 24% this July. Two weeks later, I got a letter telling me this same company was reducing our reimbursement by 21%.

Dr. McGuire, the CEO of United Healthcare, was paid 1.6 BILLION (yes Billion) dollars last year. You must know that because CALPERS was so incensed they have filed a grievance with United Healthcare. Have you looked at them? Don’t you think that is just a tad more egregious than chicken parmesan?

This article has stirred a fire in me. I am angry that people of such influence, such as you, could attack us for something like lunches. There are so many important issues to address. Fix health care for the poor; bring peace to Afghanistan, Iraq, and the Middle East. Do something meaningful about these problems, and the historically low approval rating (26%) for this Congress may improve.

If you’d like to contact me to discuss this matter further, I can be reached at ssiegel585 [at] gmail.com or 410-581-1600.

Very Sincerely,

Sanford Siegel
President, Chesapeake Urology Associates

cc. Members of the 109th Congress
The Baltimore Sun
The Baltimore Examiner
Baltimore Business Journal
Washington Post
Washington Times
The New York Times

Personal beliefs can pit healthcare workers against patients and colleagues

Monster.com has an article which details the pitfalls that await patients and healthcare workers when personal beliefs intersect with medical care. Some state laws are widening this intersection as well. The article offers potential solutions to the problem.