Friday, July 8, 2011
Dwight Golann, Dropped Medical Malpractice Claims: Their Surprising Frequency, Apparent Causes, And Potential Remedies, Health Affairs (Health Aff July 2011 vol. 30 no. 7 1343-1350 Subscription)
Marc A. Pfeffer & Marianne B. Bowler, Access to Safety Data — Stockholders versus Prescribers, NEJM
Tine Hansen-Turton, Jamie Ware, and Frank McClellan, Nurse Practitioners in Primary Care, SSRN/Temple L.Rev.
I am not a big fan of data breach statutes whether legislated by the states (usefully collected here) or the federal government, for example Sec. 13402 HITECH and regulations made thereunder (outlined here). Practically, they seem to embrace a "horse bolted after we left the barn door unlocked" approach to data protection. And,from a policy perspective, they strike me as a lazy post hoc (and sometimes sectoral) legislative responses to a problem that deserves a more comprehensive and integrated regulatory model.
Thursday, July 7, 2011
Last year I published a piece called “Beyond Innovation and Competition,” questioning the dominance of those values. Economists celebrate innovation and competition as the main source of future growth. Innovation has become the central focus of Internet law and policy. While leading commentators sharply divide on the best way to promote innovation, they routinely elevate its importance. Business writers have celebrated search engines, social networks, and tech startups as model corporations, bringing creative destruction and “disruptive innovation” in their wake. Maximum innovation is the goal, and competition is billed as the best way of achieving it. Players in the vast and dynamic tech marketplace are supposed to constantly strive to innovate in order to attract consumers away from rivals.
In the piece, I explain how both competition and innovation can be as destructive as they are constructive. There are many social values (including privacy, transparency, predictability, and stability), and companies can compete for profits in ways that erode those values. In an era of inequality and hall-of-mirrors stock market valuations, innovations of marginal or negative impact on society at large can be vastly overvalued by a stampede of fickle investors.
The shortcomings of the innovation and competition story also play out in health information technology. Stimulus legislation in 2009 provided many carrots and sticks for doctors to digitize their recordkeeping systems, ranging from bonuses now to reimbursement haircuts later this decade if they fail to implement the technology. Congress structured the incentives to encourage a competitive and innovative marketplace in health information technology. But many doctors are shying away from implementation, in part because they fear that the fast and loose ethics of the market can’t mesh with a medical culture of constant commitment to quality care.
Susan Jaffe’s article for the Center for Public Integrity examines doctors’ fears about adopting any given software suite. According to Jaffe, “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the” stimulus funds. The long-term consequences of the choice make the jam-shopping examples in Barry Schwartz’s book The Paradox of Choice seem quaint:
Monday, July 4, 2011
Many policy experts and public officials have touted electronic medical records for their promise in promoting safer, higher quality, and lower cost health care. At the same time, critics have challenged the claims that have been made on behalf of e-records. A new study demonstrates that computerizing prescriptions will not reduce medication errors as easily as has been thought.