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Any fact that needs to be disclosed should be put out Any fact that needs to be disclosed should be put out now or as quickly as possible, because otherwise the now or as quickly as possible, because otherwise the bleeding will not end.” bleeding will not end.” Henry Kissinger Henry Kissinger There are in fact two things, fact and opinion; There are in fact two things, fact and opinion; the former begets knowledge, the later the former begets knowledge, the later ignorance” ignorance” Hippocrates Hippocrates "Practical politics consists of ignoring facts." "Practical politics consists of ignoring facts." Henry Adams Henry Adams THE REAL FACTS ABOUT EMR

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THE REAL FACTS ABOUT EMR. “Any fact that needs to be disclosed should be put out now or as quickly as possible, because otherwise the bleeding will not end.” Henry Kissinger. “There are in fact two things, fact and opinion; the former begets knowledge, the later ignorance” Hippocrates. - PowerPoint PPT Presentation

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Page 1: "Practical politics consists of ignoring facts."  Henry Adams

““Any fact that needs to be disclosed should be put out now or as Any fact that needs to be disclosed should be put out now or as quickly as possible, because otherwise the bleeding will not quickly as possible, because otherwise the bleeding will not

end.” end.”

Henry KissingerHenry Kissinger

““There are in fact two things, fact and opinion; the former There are in fact two things, fact and opinion; the former begets knowledge, the later ignorance” begets knowledge, the later ignorance”

HippocratesHippocrates

"Practical politics consists of ignoring facts.""Practical politics consists of ignoring facts."

Henry AdamsHenry Adams

THE REAL FACTS ABOUT EMR

THE REAL FACTS ABOUT EMR

Page 2: "Practical politics consists of ignoring facts."  Henry Adams

Terms and AcronymsTerms and AcronymsTerms and AcronymsTerms and AcronymsMRI - Medical Records Institute, which sets many of the definitions frequently used today in reference to information technology, as explained below.CCHIT - stands for a voluntary, private-sector organization to certify HIT products. It was initially founded by three leading HIT industry associations – the American Health Information Management Association (“AHIMA”), the Healthcare Information and Management Systems Society (“HIMSS”) and The National Alliance for Health Information Technology (“Alliance”).CPOE - computerized physician order entry.C-EHR - stands for “certified electronic health record”.EHR – electronic health record, which is a computer-accessible, interoperable resource of clinical and administrative information pertinent to the health of an individual. The information, drawn from multiple clinical and administrative resources, is used by a broad spectrum of clinical personnel. This enables them to coordinate the patient's care and promote wellness.EMR – electronic medical record, which is a computer-accessible resource of medical and administrative information available on an individual collected from and accessible by health care professionals involved in the patient's care within a single care setting.HHS - Health and Human Services, currently chaired by Secretary Michael Leavitt.HIMSS EHRVA is a trade association of EHR vendors which functions as an advocacy and lobbying group founded to fight for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 it has offices in Chicago, Washington D.C., Brussels, and other locations across the United States and Europe.

Slide 2

Page 3: "Practical politics consists of ignoring facts."  Henry Adams

FACTS ABOUT CCHIT

FACTS ABOUT CCHIT

Page 4: "Practical politics consists of ignoring facts."  Henry Adams
Page 5: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 5

And now the average cost of the typical “certified” EMR is about twice as And now the average cost of the typical “certified” EMR is about twice as expensive as those that aren’t certified.expensive as those that aren’t certified.The uptake of “certified” EMR software systems has stagnated while those The uptake of “certified” EMR software systems has stagnated while those that aren’t certified have seen the overall prevalence in the market grow to that aren’t certified have seen the overall prevalence in the market grow to almost 30%.almost 30%.The failed installation rates are estimated at up to 50% in the c-EHR The failed installation rates are estimated at up to 50% in the c-EHR software systems industry; the deinstallation rate is reported to be another software systems industry; the deinstallation rate is reported to be another 8%.8%.Only 10% of those that buy c-EHR software systems Only 10% of those that buy c-EHR software systems actually use all the features that Medicare wants to actually use all the features that Medicare wants to eventually force onto physicians.eventually force onto physicians.The special “features” that government and Insurance The special “features” that government and Insurance companies want to implement have more to do with companies want to implement have more to do with withholding payment to providers than in actually withholding payment to providers than in actually improving patient care.improving patient care.

On 7/2006 CCHIT began On 7/2006 CCHIT began certifying EMR software certifying EMR software systems…systems…

•http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=349DF6BB879446A1886B65F332AC487F&nm=&type=Blog&mod+View+Topic&mid=67D6564029914AD3B204AD35D8F5F780&tier=7&id=EDE4B65E6FA344C286C02EFB2CD4D223•http://www.ihealthbeat.org/articles/2007/10/31/Survey-Finds-Health-Care-Providers-Often-Backtrack-on-EHRs.aspx?topicID=54

Page 6: "Practical politics consists of ignoring facts."  Henry Adams

Reason for the High Failed Installation

Rates

An artistic depiction of what a typical CCHIT certified “enterprise” EHR chaotic installation could look like in “real time”.

Slide 6

Page 7: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 7

Since 2006 approximately 100 EHR software systems have been Since 2006 approximately 100 EHR software systems have been CCHIT certified. Of these, 3 of which have declared bankruptcy, CCHIT certified. Of these, 3 of which have declared bankruptcy, and at least 2 dozen other certified EMR software systems have and at least 2 dozen other certified EMR software systems have seen their stocks fall in the past year alone over 30%. And these seen their stocks fall in the past year alone over 30%. And these are just the ones that are publicly traded. Little is known of the are just the ones that are publicly traded. Little is known of the majority of EHR software systems that are privately owned.majority of EHR software systems that are privately owned.On several blog sites on the ‘net there are several discussions of On several blog sites on the ‘net there are several discussions of EHR software system vendors that leave their users angry, and EHR software system vendors that leave their users angry, and on one occasion holding patient records hostage waiting for on one occasion holding patient records hostage waiting for more fees. Here are the most recent discussions:more fees. Here are the most recent discussions:

eCW eCW ((https://md.sermo.com/medical/ticket/details?nav=on&id=23060https://md.sermo.com/medical/ticket/details?nav=on&id=23060))

Cerner Cerner ((https://md.sermo.com/medical/ticket/details?nav=on&id=18593https://md.sermo.com/medical/ticket/details?nav=on&id=18593))

NextGen- discussion still active after more than a NextGen- discussion still active after more than a year! year! ((http://www.emrupdate.com/forums/t/12000.aspx?PageIndex=1http://www.emrupdate.com/forums/t/12000.aspx?PageIndex=1))

http://www.youtube.com/watch?v=cL9Wu2kWwSY

In 2006 CCHIT began certifying EMR In 2006 CCHIT began certifying EMR software systems, offering software systems, offering “assurance”…“assurance”…

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DID YOU KNOW?DID YOU KNOW?

Slide # 8

The Medicare P4P and e-prescribing rules show that the The Medicare P4P and e-prescribing rules show that the government has conspired with HIMSS “enterprise” EMR government has conspired with HIMSS “enterprise” EMR vendors to try to  force physicians to purchase a vendors to try to  force physicians to purchase a CCHIT-certified EMR in the future if they wish to be paid CCHIT-certified EMR in the future if they wish to be paid a fair wage for services rendered when they see those a fair wage for services rendered when they see those elderly patients in their practices. This could be illegal, elderly patients in their practices. This could be illegal, but…but…

There exists a situation, "extortionate extensions of credit" There exists a situation, "extortionate extensions of credit" which can apply to CCHIT-related activity:which can apply to CCHIT-related activity:

For vendors: The purported CCHIT "buy-in" certification costs For vendors: The purported CCHIT "buy-in" certification costs of $30000 if you wish to stay in business within the HIT of $30000 if you wish to stay in business within the HIT industry. industry.

Physicians: The department of HHS P4P payout of money only Physicians: The department of HHS P4P payout of money only if you purchase a CCHIT-certified EMR.if you purchase a CCHIT-certified EMR.

Legalese: "By its very nature, however, extortion causes Legalese: "By its very nature, however, extortion causes the victim to consent to the taking of property. Extortion the victim to consent to the taking of property. Extortion does not necessarily involve the use of force or the threat does not necessarily involve the use of force or the threat of the use of force. For example, the victim storeowner of the use of force. For example, the victim storeowner voluntarily pays a Mafia enforcer $1000 per month voluntarily pays a Mafia enforcer $1000 per month because the Mafia enforcer said, ‘pay us $1000 per month because the Mafia enforcer said, ‘pay us $1000 per month of we'll break your legs’”. of we'll break your legs’”.

http://www.emrupdate.com/forums/p/7953/60493.aspx#60493

Page 9: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 9

In Summary: "Governmental power, by its nature, is legalized In Summary: "Governmental power, by its nature, is legalized extortion, i.e. “unless you buy a CCHIT certified EMR you won't be able extortion, i.e. “unless you buy a CCHIT certified EMR you won't be able to make a decent living in the practice medicine in the USA to make a decent living in the practice medicine in the USA anymore…” You only have 2 options- anymore…” You only have 2 options-

Don’t vote for elected officials that don’t understand the implications of Don’t vote for elected officials that don’t understand the implications of their representation.their representation.

Don’t consent to forced HIT rules which may pay you an extra pittance Don’t consent to forced HIT rules which may pay you an extra pittance for “consent” or participation which legitimizes the process further.for “consent” or participation which legitimizes the process further.

http://www.emrupdate.com/forums/p/7953/60493.aspx#60493

The Medicare P4P and e-prescribing rules show that the The Medicare P4P and e-prescribing rules show that the government has conspired with HIMSS “enterprise” EMR government has conspired with HIMSS “enterprise” EMR vendors to try to  force physicians to purchase a vendors to try to  force physicians to purchase a CCHIT-certified EMR in the future if they wish to be paid CCHIT-certified EMR in the future if they wish to be paid a fair wage for services rendered when they see those a fair wage for services rendered when they see those elderly patients in their practices. This could be illegal, elderly patients in their practices. This could be illegal, but…but…

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DID YOU KNOW?DID YOU KNOW?

Slide # 10

If you try to work with CCHIT, all you end up doing is If you try to work with CCHIT, all you end up doing is giving this politically contrived public/private company giving this politically contrived public/private company more validity. Its whole premise is wrong and flaunts more validity. Its whole premise is wrong and flaunts the Clayton and Sherman antitrust acts simply because the Clayton and Sherman antitrust acts simply because of the backing of the Department of Health and Human of the backing of the Department of Health and Human Services. Services.

CCHIT functions not unlike the mafia, providing a CCHIT functions not unlike the mafia, providing a method of racketeering in which if you didn't pay their method of racketeering in which if you didn't pay their $30000.00 a year, your business dies. This decreases $30000.00 a year, your business dies. This decreases competition, leading to increased prices that impacts competition, leading to increased prices that impacts every physician office in the USA. On top of this they every physician office in the USA. On top of this they through massive donations which are usually poorly through massive donations which are usually poorly known, they have been able to get bipartisan support to known, they have been able to get bipartisan support to force doctors into purchasing their bloated, costly, force doctors into purchasing their bloated, costly, difficult to use EMR software. difficult to use EMR software.

Occasionally a Physician May Claim: “Occasionally a Physician May Claim: “It would It would however be more positive and productive if doctors however be more positive and productive if doctors as a profession would actually accept the challenge as a profession would actually accept the challenge and work with CCHIT to design appropriately and work with CCHIT to design appropriately suitable standards.”suitable standards.”

“An Antitrust Primer”- http://www.emrupdate.com/forums/p/7196/56269.aspx#56269

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DID YOU KNOW?DID YOU KNOW?

Slide # 11

When I first began looking into this, I found that CCHIT itself, a When I first began looking into this, I found that CCHIT itself, a “nonprofit” organization, had planned on making a million dollars “nonprofit” organization, had planned on making a million dollars in the first 6 months of existence in 2006, then divide the profits in the first 6 months of existence in 2006, then divide the profits at the end of the year. I exposed that, and subsequently they at the end of the year. I exposed that, and subsequently they reorganized on 11/2006. Subsequently, an article stated that reorganized on 11/2006. Subsequently, an article stated that Cerner spent $180,000 in its lobbying efforts in Q1 of 2008 in Cerner spent $180,000 in its lobbying efforts in Q1 of 2008 in Congress to forward the agenda of the "enterprise" EHR.Congress to forward the agenda of the "enterprise" EHR.

So those that are contemplating on working with this process- So those that are contemplating on working with this process- don’t!don’t!

Occasionally a Physician May Claim: “Occasionally a Physician May Claim: “It would It would however be more positive and productive if doctors however be more positive and productive if doctors as a profession would actually accept the challenge as a profession would actually accept the challenge and work with CCHIT to design appropriately suitable and work with CCHIT to design appropriately suitable standards.” (continued)standards.” (continued)

URL for the CCHIT original charter and minutes demonstrating how not-for-profit CCHIT was going to make a profit in 2006: http://msofficeemrproject.com/Page3.htm

Page 12: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 12

Incorporated as an LLC in 2004, reincorporated as a non-Incorporated as an LLC in 2004, reincorporated as a non-profit C-corporation in 2006.profit C-corporation in 2006.

CCHIT’s address on the tax form is 200 S. Wacker Drive, CCHIT’s address on the tax form is 200 S. Wacker Drive, Chicago, IL 60606.Chicago, IL 60606.

CCHIT took in $4.7 million in FY2007, spent $3.6 million of CCHIT took in $4.7 million in FY2007, spent $3.6 million of that, and banked $1.1 million, bringing its fund balance up that, and banked $1.1 million, bringing its fund balance up to $2.7 million and total assets of $3.4 million. to $2.7 million and total assets of $3.4 million.

Of the $4.7 million in income, $2 million was from Of the $4.7 million in income, $2 million was from certification fees, $2.7 million was from government certification fees, $2.7 million was from government contracts. contracts.

CCHIT reported $866K transferred to AHIMA (the CCHIT reported $866K transferred to AHIMA (the “enterprise” EHR vendor lobbying group) in a category that “enterprise” EHR vendor lobbying group) in a category that includes sharing of equipment, facilities, or employees. includes sharing of equipment, facilities, or employees. HIMSS HIMSS

received $196K for a category that includes received $196K for a category that includes

performance of membership services. performance of membership services.

CCHIT Facts According to Histalk:CCHIT Facts According to Histalk:

http://histalk2.com/2009/02/21/monday-morning-update-22309/

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DID YOU KNOW?DID YOU KNOW?

Slide # 13

The tax records indicate that CCHIT chair The tax records indicate that CCHIT chair Mark Leavitt is still a Mark Leavitt is still a HIMSS employeeHIMSS employee, "on leave from his position as HIMSS’ Chief , "on leave from his position as HIMSS’ Chief Medical Officer while serving as Chair of CCHIT. CCHIT pays Medical Officer while serving as Chair of CCHIT. CCHIT pays HIMSS an hourly rate for Dr. Leavitt’s services that is intended to HIMSS an hourly rate for Dr. Leavitt’s services that is intended to cover the portion of his salary and benefits allocable to those cover the portion of his salary and benefits allocable to those hours." That’s at odds with both his CCHIT bio and his LinkedIn hours." That’s at odds with both his CCHIT bio and his LinkedIn write-up, which say he’s finished with HIMSS and working full-write-up, which say he’s finished with HIMSS and working full-time for CCHIT (he put on LinkedIn that he left HIMSS in time for CCHIT (he put on LinkedIn that he left HIMSS in September 2005), although on tax forms he is shown as being September 2005), although on tax forms he is shown as being paid $164K for 40 hours a week at CCHIT, possibly more.paid $164K for 40 hours a week at CCHIT, possibly more.

http://histalk2.com/2009/02/21/monday-morning-update-22309/

CCHIT Facts According to Histalk:CCHIT Facts According to Histalk:

Page 14: "Practical politics consists of ignoring facts."  Henry Adams

FACTS: THE ECONOMICS ABOUT

BUYING A c-EMR SOFTWARE SYSTEM

FACTS: THE ECONOMICS ABOUT

BUYING A c-EMR SOFTWARE SYSTEM

Page 15: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 15

First you have to find a hospital willing to donate money to your cause.First you have to find a hospital willing to donate money to your cause.

By law, the most that the hospital can buy is 85% of the initial outlay of By law, the most that the hospital can buy is 85% of the initial outlay of the EMR.the EMR.

The hospital will not cover the training, which can cost as much as the The hospital will not cover the training, which can cost as much as the EMR itself.EMR itself.

You still have to pay for-You still have to pay for- The yearly ongoing fees, usually costing about 15% of the initial cost.The yearly ongoing fees, usually costing about 15% of the initial cost. The cost of the hardware which can handle an SQL server backend, The cost of the hardware which can handle an SQL server backend,

plus the technical assistance to make it work.plus the technical assistance to make it work.

You still have the loss of productivity associated with workflow disruption You still have the loss of productivity associated with workflow disruption that in many cases does not improve with time.that in many cases does not improve with time.

The response to date has been lukewarm due to both hospital and The response to date has been lukewarm due to both hospital and physician reluctance to enter into binding agreements, costs, and physician reluctance to enter into binding agreements, costs, and problems related to patient confidentiality.problems related to patient confidentiality.

If you try to take advantage of the If you try to take advantage of the Stark Stark

Law Relaxation to allow hospitals to Law Relaxation to allow hospitals to buy buy

you an EMR…you an EMR…

http://www.hschange.com/CONTENT/1015/

Page 16: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 16

As stated in the previous slide, the initial and ongoing costs As stated in the previous slide, the initial and ongoing costs provide a large hurdle to overcome before a provider begins to provide a large hurdle to overcome before a provider begins to “make money”.“make money”.Just the 50% failed installation rate, the 8% deinstallation rate, and Just the 50% failed installation rate, the 8% deinstallation rate, and for those that do install the EMR, the 90% less-than-full use, and for those that do install the EMR, the 90% less-than-full use, and lastly the loss of productive workflow, alone will kill any possible lastly the loss of productive workflow, alone will kill any possible increased income using an expensive CCHIT-certified EHR.increased income using an expensive CCHIT-certified EHR.In 2 case studies published at the In 2 case studies published at the www.aafp.comwww.aafp.com site, the total site, the total outlay just for the technology was reported to cost anywhere outlay just for the technology was reported to cost anywhere between $125,000.00 to as much as a $250,000.00 for 2 doctors between $125,000.00 to as much as a $250,000.00 for 2 doctors over the first 5 years (2002 dollars).over the first 5 years (2002 dollars).

Multiple Vendors Claim:Multiple Vendors Claim: “Physicians need to “Physicians need to understand that this is an investment, so they understand that this is an investment, so they will not only make their initial costs back, but in will not only make their initial costs back, but in the next five years, they could make an extra the next five years, they could make an extra $125,000!” $125,000!”

•The two aafp website articles referenced above: http://www.aafp.org/fpm/20020400/57howm.html and http://www.aafp.org/fpm/20030500/37impl.html)•http://www.emrupdate.com/blogs/ducknet/archive/2008/10/01/ehr-adoption-remains-off-in-the-distance-getting-way-to-complicated.aspx

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DID YOU KNOW?DID YOU KNOW?

Slide # 17

The 2/13/2009 stimulus bill’s $44,000.00 The 2/13/2009 stimulus bill’s $44,000.00 incentive payment for “significant use” incentive payment for “significant use” of a c-EHR may seem like a lot, but not really…of a c-EHR may seem like a lot, but not really…

The current (2009) estimated average cost of purchasing an EHR system is The current (2009) estimated average cost of purchasing an EHR system is $33,000 for each physician, with an additional cost of $1,500 per doctor per $33,000 for each physician, with an additional cost of $1,500 per doctor per month for maintenance. So if you do the math, $33000.00 plus $1500 x month for maintenance. So if you do the math, $33000.00 plus $1500 x 60months = 60months = $123000.00$123000.00 ( (http://blog.case.http://blog.case.eduedu/case-news/2008/10/30//case-news/2008/10/30/ehrregulationehrregulation))

Add to that 1/3 of a full-time employee to follow the trail of the reporting Add to that 1/3 of a full-time employee to follow the trail of the reporting and documentation, and it comes out to another $10000.00/year x 5 years and documentation, and it comes out to another $10000.00/year x 5 years = = $50,000.00$50,000.00

Workflow losses: The costs of P4P with the added extra data input needed Workflow losses: The costs of P4P with the added extra data input needed to capture the “granular data” is an estimate, as the specifics haven’t been to capture the “granular data” is an estimate, as the specifics haven’t been posted yet, but say it takes an extra 5 minutes per encounter. An office posted yet, but say it takes an extra 5 minutes per encounter. An office grossing $100,000.00 a year in Medicare funds, at $100.00 per encounter, grossing $100,000.00 a year in Medicare funds, at $100.00 per encounter, equals to 1000 encounters. Do the math again- 1000 x 5 min/encounter = equals to 1000 encounters. Do the math again- 1000 x 5 min/encounter = 5000 minutes; 5000 minutes;

5000/20 min per encounter = 250 “lost” encounters, or 5000/20 min per encounter = 250 “lost” encounters, or

another $25000.00/year x 5 years = another $25000.00/year x 5 years = $125,000.00$125,000.00

Total losses over 5 years: Total losses over 5 years: $298,000.00$298,000.00

http://www.hcplive.com/mdnglive/articles/PC_Medicare_HIT_mandate

Page 18: "Practical politics consists of ignoring facts."  Henry Adams

FACTS ABOUT E-EHR SOFTWARE

SYSTEMS AND QUALITY

FACTS ABOUT E-EHR SOFTWARE

SYSTEMS AND QUALITY

Page 19: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 19

But there is not one prospective study demonstrating this But there is not one prospective study demonstrating this fact.fact.

There are several showing the opposite, s.a.There are several showing the opposite, s.a. In one study published in 2005 involved a pediatrics ICU using In one study published in 2005 involved a pediatrics ICU using

EHR and CPOE systems. The final result was that more children EHR and CPOE systems. The final result was that more children died using HIT- “Univariate analysis revealed that mortality rate died using HIT- “Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation to 6.57% (36 of 548) after CPOE implementation. ”implementation. ”

In another study, the CPOE system was so bad that physicians In another study, the CPOE system was so bad that physicians could not put in the orders in a timely manner, and after only 3 could not put in the orders in a timely manner, and after only 3 months the whole project was discontinued. See “Cedars-Sinai months the whole project was discontinued. See “Cedars-Sinai Doctors Cling to Pen and Paper” URL below.Doctors Cling to Pen and Paper” URL below.

•Pediatrics, Vol. 116, No. 6. (December 2005), pp. 1506-1512, http://www.citeulike.org/user/scheufele/article/505501•http://www.washingtonpost.com/wp-dyn/articles/A52384-2005Mar20.html?sub=AR

Big government, EHR vendors, health insurers, and Big government, EHR vendors, health insurers, and Presidents Bush & Obama all believe that EHR Presidents Bush & Obama all believe that EHR software systems improve quality & save lives…software systems improve quality & save lives…

Page 20: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 20

In 2007 one study, published in the In 2007 one study, published in the Archives of Internal Archives of Internal MedicineMedicine, showed that for 14 of the 17 quality indicators, , showed that for 14 of the 17 quality indicators, therethere was no significant difference in performance between was no significant difference in performance between visitsvisits with vs. without EHR use. with vs. without EHR use.

In 2008 a study performed at the Richmond, VA In 2008 a study performed at the Richmond, VA MCV/University of Richmond Medical Center they concluded MCV/University of Richmond Medical Center they concluded that for 10 quality indicators, “that for 10 quality indicators, “…… there is limited evidence of there is limited evidence of the relationship between hospitalthe relationship between hospital EMR use and quality.EMR use and quality.””

•http://archinte.ama-assn.org/cgi/content/abstract/167/13/1400•http://mcr.sagepub.com/cgi/content/abstract/65/4/496

Big government, EHR vendors, health insurers, and Big government, EHR vendors, health insurers, and Presidents Bush & Obama all believe that EHR Presidents Bush & Obama all believe that EHR software systems improve quality & save lives… software systems improve quality & save lives… (continued)(continued)

Page 21: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 21

But this was a retrospective study which involved varied amounts But this was a retrospective study which involved varied amounts of EMR use by practitioners.of EMR use by practitioners.The survey response rate was only 71.4% (1345 of 1884), and only The survey response rate was only 71.4% (1345 of 1884), and only 1140 respondents of these had significant data on the presence of 1140 respondents of these had significant data on the presence of EHR. EHR. The purported 40% reduction was not statistically significant: “The purported 40% reduction was not statistically significant: “In In logistic regression analysis controlling for sex, race, year of medical logistic regression analysis controlling for sex, race, year of medical school graduation, specialty, and practice size, the relationship school graduation, specialty, and practice size, the relationship between EHR adoption and paid malpractice settlements was of between EHR adoption and paid malpractice settlements was of smaller magnitude and no longer statistically significant (adjusted smaller magnitude and no longer statistically significant (adjusted odds ratio, 0.69; 95% confidence interval, 0.40-1.20; P = .18).odds ratio, 0.69; 95% confidence interval, 0.40-1.20; P = .18).””A subgroup analysis revealed that although only 5.7% of frequent A subgroup analysis revealed that although only 5.7% of frequent EMR users had paid malpractice claims, compared to 10.8% of EMR users had paid malpractice claims, compared to 10.8% of those not using an EMR, those that infrequently/partially used an those not using an EMR, those that infrequently/partially used an EMR (s.a. "hybrid systems") faired WORSE than those using only EMR (s.a. "hybrid systems") faired WORSE than those using only paper records (12.1%).paper records (12.1%).The facts remain that despiteThe facts remain that despite the cheerleading for EMR software the cheerleading for EMR software systems there’s still not a shred of evidence they have a systems there’s still not a shred of evidence they have a significant impact on outcomes that matter.significant impact on outcomes that matter.

http://archinte.ama-assn.org/cgi/content/abstract/168/21/2362

One study “finally showed” that EMR One study “finally showed” that EMR software systems might lower software systems might lower malpractice risk…malpractice risk…

Page 22: "Practical politics consists of ignoring facts."  Henry Adams

DID YOU KNOW?DID YOU KNOW?

Slide # 22

““For one thing, an overarching concern is that Federal Rules For one thing, an overarching concern is that Federal Rules of Civil Procedure, approved by the U.S. Supreme Court in of Civil Procedure, approved by the U.S. Supreme Court in December 2006, make any electronically-stored data December 2006, make any electronically-stored data discoverable in a trial--and those details can catch doctors discoverable in a trial--and those details can catch doctors off guard.”off guard.”

Doctors may run into problems if the EMR software systems’ Doctors may run into problems if the EMR software systems’ metadata (the time stamp indicating who entered what and metadata (the time stamp indicating who entered what and when) conflicts with his or her version of events. when) conflicts with his or her version of events.

““Perhaps even more vexing, it's still not clear what the legal Perhaps even more vexing, it's still not clear what the legal status of an EMR is. At present, it's still in question whether status of an EMR is. At present, it's still in question whether all EMR software systems meet the legal definition of being all EMR software systems meet the legal definition of being medical records, a concern that could become important in medical records, a concern that could become important in some forms of legal disputes over patient care.”some forms of legal disputes over patient care.”

On the contrary, another more recent On the contrary, another more recent study showed the opposite- that “EMR study showed the opposite- that “EMR software systems pose new legal risks”software systems pose new legal risks”

http://www.fiercehealthit.com/story/emrs-pose-new-legal-risks/2008-10-06

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DID YOU KNOW?DID YOU KNOW?

Slide # 23

This bill was pure politics at its worse.This bill was pure politics at its worse.For most practitioners, e-prescribing is a workflow slowing For most practitioners, e-prescribing is a workflow slowing tedious procedure. tedious procedure. Allscripts claims that they offer a “free” system, but it’s a Allscripts claims that they offer a “free” system, but it’s a marketing ploy. Its database is not “open source” and no plans marketing ploy. Its database is not “open source” and no plans are in the works to make it accessible to most EMR software are in the works to make it accessible to most EMR software systems so as to prevent double entry. This "free" e-prescribing systems so as to prevent double entry. This "free" e-prescribing is what convinced Congress to put e-prescribing on their recent is what convinced Congress to put e-prescribing on their recent 7/2008 HR 6331 bill. 7/2008 HR 6331 bill. Although on 7/2008 there were up to 10% of physicians capable Although on 7/2008 there were up to 10% of physicians capable of e-prescribing, only 2% of prescriptions actually were of e-prescribing, only 2% of prescriptions actually were legitimately sent by e-prescribing as described by law.legitimately sent by e-prescribing as described by law.It was meant to make a transition from handwritten It was meant to make a transition from handwritten prescriptions to a format that was more legible overall, but prescriptions to a format that was more legible overall, but what is not known is why they prohibited the faxing or simple what is not known is why they prohibited the faxing or simple printing of prescriptions from an printing of prescriptions from an EMR?EMR?

On 7/2008 Congress passed a bill On 7/2008 Congress passed a bill forcing doctors to use e-prescribing forcing doctors to use e-prescribing or suffer a cut in reimbursement… or suffer a cut in reimbursement…

https://md.sermo.com/medical/ticket/details?nav=on&id=21117

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FACT: C-EHR SOFTWARE FACT: C-EHR SOFTWARE SYSTEM AGENDAS HAVE SYSTEM AGENDAS HAVE

MORE TO DO WITH MORE TO DO WITH POWER, MONEY, AND POWER, MONEY, AND

GREEDGREED

FACT: C-EHR SOFTWARE FACT: C-EHR SOFTWARE SYSTEM AGENDAS HAVE SYSTEM AGENDAS HAVE

MORE TO DO WITH MORE TO DO WITH POWER, MONEY, AND POWER, MONEY, AND

GREEDGREED

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Slide # 25

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

You have to follow the money. The internet first mentions a relationship You have to follow the money. The internet first mentions a relationship that Obama has had with a technology guy call Robert Blackwell who that Obama has had with a technology guy call Robert Blackwell who kept him, a newly minted lawyer, on retainer. Blackwell seemed to later kept him, a newly minted lawyer, on retainer. Blackwell seemed to later get quid pro quo payments where his company, EKI (“Electronic get quid pro quo payments where his company, EKI (“Electronic Knowledge Interchange”) profited. Knowledge Interchange”) profited. EKI is a business and technology consulting firm that specializes in EKI is a business and technology consulting firm that specializes in delivering measurable business value to mid to large size corporate delivering measurable business value to mid to large size corporate and government organizations, which is something that Obama wants and government organizations, which is something that Obama wants to bring to health care through the use of c-EHR systems. to bring to health care through the use of c-EHR systems. Obama’s presidential campaign website reported that Obama’s presidential campaign website reported that Blackwell in 2008 committed to raise between Blackwell in 2008 committed to raise between $100,000 and $200,000 for Obama’s White House $100,000 and $200,000 for Obama’s White House run that year. I'm sure that eventually we'll be hearing run that year. I'm sure that eventually we'll be hearing more of this Blackwell relationship. more of this Blackwell relationship. 

• http://citizenwells.wordpress.com/2008/04/29/robert-blackwell-obama-money-laundering-eki-consulting-rod-blagojevich-illinois-tony-rezko/ • http://news.lavenderliberal.com/2008/04/27/obama-supporters-how-do-you-justify-barrys-blackwell-eki-killerspin-wheeling-and-dealing/

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DID YOU KNOW?DID YOU KNOW?

Slide # 26

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

TULLMAN:TULLMAN: Shortly after Obama gets elected, he makes Glen Tullman, Shortly after Obama gets elected, he makes Glen Tullman, CEO of CEO of AllscriptsAllscripts, his personal IT advisor. , his personal IT advisor.

Mr. Tullman personally gave President Obama at least Mr. Tullman personally gave President Obama at least $144300.00 in donations in the 2 years prior to his election. His $144300.00 in donations in the 2 years prior to his election. His employees gave $20662 during the same period. His company, employees gave $20662 during the same period. His company, Allscripts/Misys also gave the possible future HHS Secretary Daschle Allscripts/Misys also gave the possible future HHS Secretary Daschle $12000 speaking fees on 8/2008 for a lecture.$12000 speaking fees on 8/2008 for a lecture.

This lobbying put him into the unusual position where he can This lobbying put him into the unusual position where he can influence legislation which can ultimately enrich himself by forcing the influence legislation which can ultimately enrich himself by forcing the use of e-prescribing and c-EHR systems while the American taxpayer, use of e-prescribing and c-EHR systems while the American taxpayer, and especially doctors have to foot the bill. and especially doctors have to foot the bill.

•http://histalk2.com/2009/02/05/histalk-interviews-glen-tullman-ceo-of-allscripts-2509/•http://hotair.com/archives/2008/04/27/an-obama-payoff/ • http://www.talkleft.com/story/2008/4/27/145012/154 • http://www.obamamustgo.com/• http://www.discoverthenetworks.org/Articles/blackwell5.html

•http://www.campaignmoney.com/political/contributions/glen-tullman.asp?cycle=08•http://fundrace.huffingtonpost.com/neighbors.php?type=emp&employer=ALLSCRIPTS•http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x4968435

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DID YOU KNOW?DID YOU KNOW?

Slide # 27

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

On a more recent note, several of Obama's health information technology related On a more recent note, several of Obama's health information technology related appointees have been found to be "problematic" (I'm trying to be kind here):appointees have been found to be "problematic" (I'm trying to be kind here):DASCHLE:DASCHLE: Allscripts/Misys (CEO Glen Tullman's company) also gave the possible Allscripts/Misys (CEO Glen Tullman's company) also gave the possible future HHS Secretary Daschle $12,000.00 speaking fees on 8/2008 for a lecture. future HHS Secretary Daschle $12,000.00 speaking fees on 8/2008 for a lecture. Fortunately "buy me out" Daschle failed to pay his taxes, so he had to resign.Fortunately "buy me out" Daschle failed to pay his taxes, so he had to resign.KUNDRA:KUNDRA:  On   On 3/10/2009 3/10/2009 the FBI raided the former office of one of President the FBI raided the former office of one of President Obama's appointees, Vivek Kundra. An employee of the D.C. Office of the Chief Obama's appointees, Vivek Kundra. An employee of the D.C. Office of the Chief Technology Officer and a private contractor were charged with corruption, Technology Officer and a private contractor were charged with corruption, including bribery of a public official, money laundering, wire fraud and conflict of including bribery of a public official, money laundering, wire fraud and conflict of interest.  As the raid took place, Obama's appointee, Kundra, was giving a speech at interest.  As the raid took place, Obama's appointee, Kundra, was giving a speech at FOSE - an annual government technology expo - about changing the way the FOSE - an annual government technology expo - about changing the way the government purchases materials from vendors. Kundra is on leave from his White government purchases materials from vendors. Kundra is on leave from his White House job until further details of the case become known, a White House House job until further details of the case become known, a White House source told the Associated Press. He was at source told the Associated Press. He was at the job only 7 days before this the job only 7 days before this occurred; if he stays on, he would be an integral part of the push to c-EHRs. occurred; if he stays on, he would be an integral part of the push to c-EHRs.

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x4968435http://voices.washingtonpost.com/posttech/2009/03/vivek_kundra_to_be_obamas_chie.html  http://www.huffingtonpost.com/2009/03/12/fbi-raids-obama-technolog_n_174265.html  http://groups.google.com/group/alt.politics.democrats.d/browse_thread/thread/6c3ddc4a3f4bee10  

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Slide # 28

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

Other lobbyists include:Other lobbyists include:

DEPARLE:DEPARLE: President Obama's health technology "czar", President Obama's health technology "czar", Nancy-Ann DeParle, has some deep financial ties to the Nancy-Ann DeParle, has some deep financial ties to the healthcare industry she’s supposed to reform. Among healthcare industry she’s supposed to reform. Among them is the fact that she served as a them is the fact that she served as a Cerner board Cerner board membermember since 2001 and that she was paid $195K in stock since 2001 and that she was paid $195K in stock and cash and held around $1 million of CERN shares at and cash and held around $1 million of CERN shares at the end of 2007.  She donated $39,400.00 to various the end of 2007.  She donated $39,400.00 to various Democratic party officials. On 3/6/2009 she resigned from Democratic party officials. On 3/6/2009 she resigned from Cerner's board. Cerner's board.

http://content.nejm.org/cgi/content/full/NEJMp0901592http://content.nejm.org/cgi/content/full/NEJMp0901592http://www.chicagotribune.com/news/nationworld/chi-deparlemar29,0,7090806.storyhttp://www.chicagotribune.com/news/nationworld/chi-deparlemar29,0,7090806.storyhttp://www.histalkpractice.com/2009/03/02/news-3309/  http://www.campaignmoney.com/finance.asp?type=in&cycle=08&criteria=DeParle

BLUMENTHAL:BLUMENTHAL: President Obama recently selected President Obama recently selected David Blumenthal M.D., to serve as national coordinator David Blumenthal M.D., to serve as national coordinator within the U.S. Department of Health and Human within the U.S. Department of Health and Human Services. Blumenthal was director of the Institute for Services. Blumenthal was director of the Institute for Health Policy at Massachusetts General Hospital in Health Policy at Massachusetts General Hospital in Boston, part of Partners.Boston, part of Partners. An interesting disclosure: he is An interesting disclosure: he is receiving grant support fromreceiving grant support from GE Healthcare GE Healthcare. .

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Slide # 29

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

An editor from the Chicago Tribune questions how DeParle and others in this An editor from the Chicago Tribune questions how DeParle and others in this administration can avoid conflicts of interest, particularly given the size and administration can avoid conflicts of interest, particularly given the size and market share of some of the firms they have served. market share of some of the firms they have served.

"What the administration is going to have to guard against is this perception that "What the administration is going to have to guard against is this perception that there is some benefit given to companies who know people in the there is some benefit given to companies who know people in the administration."administration."

http://www.chicagotribune.com/news/nationworld/chi-deparlemar29,0,7090806.storyhttp://www.chicagotribune.com/news/nationworld/chi-deparlemar29,0,7090806.story

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DID YOU KNOW?DID YOU KNOW?

Slide # 30

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

FRIEDEN:FRIEDEN: Dr. Thomas Frieden, M.D., an infectious disease specialist, who Dr. Thomas Frieden, M.D., an infectious disease specialist, who worked at the CDC from 1990 to 2002 as an Epidemiologic Intelligence Service worked at the CDC from 1990 to 2002 as an Epidemiologic Intelligence Service Officer investigating a range of issues include the spread of multidrug-resistant Officer investigating a range of issues include the spread of multidrug-resistant tuberculosis, who served as the former Chairman of the New York City tuberculosis, who served as the former Chairman of the New York City Department of Health and Mental Hygiene since January 2002, has been named Department of Health and Mental Hygiene since January 2002, has been named by President Obama as the director of the Centers for Disease Control and by President Obama as the director of the Centers for Disease Control and Prevention. Prevention.

Frieden has been a strong advocate of electronic health records, and Frieden has been a strong advocate of electronic health records, and as such his department two years ago signed a $19.8 million contract to fund as such his department two years ago signed a $19.8 million contract to fund deployment in underserved areas of integrated practice management/electronic deployment in underserved areas of integrated practice management/electronic records software from records software from eClinicalWorks Inc. (eCW)eClinicalWorks Inc. (eCW), Westborough, Mass. , Westborough, Mass.

I suspect that he will be the the fourth c-EHR system I suspect that he will be the the fourth c-EHR system lobbyist surrounding Obama, representing eCW. To date lobbyist surrounding Obama, representing eCW. To date I was not able to find the exact behind the scenes reason I was not able to find the exact behind the scenes reason for his strong patronage of this particular EMR… but I’m for his strong patronage of this particular EMR… but I’m still looking.still looking.

http://www.healthdatamanagement.com/news/CDC-28210-1.html?ET=healthdatamanagement:e872:555a:&st=email&channel=disease_management

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Slide # 31

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

GLASER:GLASER: Mr. John Glaser, VP & CIO Mr. John Glaser, VP & CIO Partners HealthcarePartners Healthcare in in Boston was appointed to a 6 month stint as an adviser to David Boston was appointed to a 6 month stint as an adviser to David Blumenthal, the recently appointed national coordinator for HIT. Blumenthal, the recently appointed national coordinator for HIT. Glaser will spend 4 days/week for 6 months working with ONC.Glaser will spend 4 days/week for 6 months working with ONC.

Blumenthal, a practicing physician and Harvard Blumenthal, a practicing physician and Harvard Medical School professor most recently worked for Medical School professor most recently worked for Partners HealthCare as director of the Institute for Health Partners HealthCare as director of the Institute for Health Policy at Massachusetts General Hospital.Policy at Massachusetts General Hospital.

Glaser is a fellow of HIMSS, CHIME and the Glaser is a fellow of HIMSS, CHIME and the American College of Medical Informatics. He also serves American College of Medical Informatics. He also serves on the editorial board of Healthcare IT News and is a on the editorial board of Healthcare IT News and is a regular columnist at www.histalk.com.regular columnist at www.histalk.com.

http://www.healthcareitnews.com/news/glaser-advise-onc-chief-hitech

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Slide # 32

There is a dark side to the certified EHR software There is a dark side to the certified EHR software systems currently being pushed by President systems currently being pushed by President Obama- a World Where Money Buys Power, Obama- a World Where Money Buys Power, Greed, and the Ability to Manipulate the President Greed, and the Ability to Manipulate the President of the United States:of the United States:

PARK:PARK: On 8/3/2009 On 8/3/2009 Mr. Todd Park, co-founder and board Mr. Todd Park, co-founder and board member of member of AthenahealthAthenahealth, has been named CTO of the US , has been named CTO of the US Department of Health and Human Services. He resigned from Department of Health and Human Services. He resigned from Athenahealth’s board on 8/10/2009 and had promised to divest Athenahealth’s board on 8/10/2009 and had promised to divest his Athenahealth stock position. Park will report to Deputy HHS his Athenahealth stock position. Park will report to Deputy HHS Secretary William. Secretary William.

Athenahealth (Nasdaq: ATHN), another “enterprise” level EHR Athenahealth (Nasdaq: ATHN), another “enterprise” level EHR vendor is a leading provider of internet based business services vendor is a leading provider of internet based business services for physician practices, and received the 2008 Certification for physician practices, and received the 2008 Certification Commission for Healthcare Information Technology (CCHIT) for Commission for Healthcare Information Technology (CCHIT) for its AthenaClinicalsSM Version 9.15.1.its AthenaClinicalsSM Version 9.15.1.

http://histalk2.com/2009/08/03/todd-park-athenahealth-co-founder-named-cto-of-hhs/

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SUMMARY FACT

STATEMENTS

SUMMARY FACT

STATEMENTS

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Physicians do NOT like c-EHR systems.Physicians do NOT like c-EHR systems. EMR does NOT save time.EMR does NOT save time. EMR does NOT improve workflow, and most likely will make EMR does NOT improve workflow, and most likely will make

it worse.it worse. EMR does NOT save money, especially for the doctor.EMR does NOT save money, especially for the doctor. EMR does NOT make a physician money and will NOT offer a EMR does NOT make a physician money and will NOT offer a

ROI.ROI. EMR has NOT been demonstrated to improve quality of care EMR has NOT been demonstrated to improve quality of care

over paper in prospective studies when looking at the same over paper in prospective studies when looking at the same quality measures.quality measures. EMR does NOT prevent redundant testing.EMR does NOT prevent redundant testing. EMR does NOT lessen your risk of malpractice litigation.EMR does NOT lessen your risk of malpractice litigation.

•https://md.sermo.com/medical/ticket/details?nav=on&id=24242•https://md.sermo.com/medical/ticket/details?nav=on&id=31562

EMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARYList of quick facts about List of quick facts about EMR:EMR:

Slide 34

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EMR does NOT save paper.EMR does NOT save paper. EMR CAN bring organization to an office.EMR CAN bring organization to an office. EMR WILL print out a hell of a 3 page consultation on an EMR WILL print out a hell of a 3 page consultation on an

OV for a sore throat, whether or not the patient was seen.OV for a sore throat, whether or not the patient was seen. EMR WILL erode the patient privacy and make EMR WILL erode the patient privacy and make

everyone's file available to government, insurance everyone's file available to government, insurance companies, and anyone else who wants to see it.companies, and anyone else who wants to see it. The c-EHR agenda has more to do with power, money, The c-EHR agenda has more to do with power, money,

and greed than with issues of quality, errors, and ROI.and greed than with issues of quality, errors, and ROI.

https://md.sermo.com/medical/ticket/details?nav=on&id=31562

More of the list of quick facts about More of the list of quick facts about EMR:EMR:

EMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARY

Slide 35

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Finally, quotes from Finally, quotes from David C. KibbeDavid C. Kibbe::EMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARYEMR FACT SUMMARY

Dr. Borges in his organized office using his EMR!

Slide 36http://www.washingtonpost.com/wp-dyn/content/article/2009/05/20/AR2009052003600.html

"One has to question whether or not a vendor-"One has to question whether or not a vendor-founded, vendor-funded and vendor-driven organization founded, vendor-funded and vendor-driven organization should have the exclusive right to determine what should have the exclusive right to determine what software will be bought by federal taxpayer dollars.“software will be bought by federal taxpayer dollars.“

"It's important that the people who determine how "It's important that the people who determine how this money is spent are disinterested and unbiased . . . this money is spent are disinterested and unbiased . . . Even the appearance of a conflict of interest could poison Even the appearance of a conflict of interest could poison the whole process.the whole process." "