Category: Blog

A September report from the Government Accountability Office (GAO) found that while progress is being made in terms of electronic health records (EHR) interoperability, healthcare providers in the United States are still far away from full implementation.  Interoperability is the idea that different EHR systems would be able to pass information to each other.  The study primarily looked at 18 initiatives currently being engaged in by nonfederal stakeholders, although the study recognized the necessity of the federal government in EHR implementation.  In examining these programs, GAO found five challenges: “(1) insufficiencies in health data standards, (2) variation in state privacy rules, (3) accurately matching patients’ health records, (4) costs associated with interoperability, and (5) the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.”  The study also found that a key to moving EHR interoperability forward will be the recognition by health care providers that it is a valuable tool for improving clinical care.

EHR implementation was mandated in 2009 by the Centers for Medicare and Medicaid Services (CMS) and the Office of National Coordinator for Health IT.  The initiative CMS began, known as “meaningful use,” was a three-phase-in-five-years program started in 2011 to encourage healthcare providers to begin using EHR.  The first stage focused on getting Medicare eligible healthcare providers to eliminate manila folders and replace them with standardized, electronic formats, which patients would have access to through an online portal.  In the second stage, Medicare eligible providers needed to meet a quota of 5% of patients being on EHR if that health care provider wished to qualify for the EHR Incentives Program (which is managed by CMS).  In 2014, when the second phase was supposed to end, 48% of Medicare eligible professionals and 65% of Medicare eligible hospitals met the phase 2 quota.  Due to the low numbers, the 5% quota has been extended until 2017, and in 2018 the quota will rise to 10%.

Additionally, there have been issues getting doctors and patients to accept EHR.  Patients who are relatively healthy are not all that interested in monitoring their health, and the programs are not overly consumer friendly for patients and doctors alike – often containing long drop down menus and producing documents up to 70 pages long. These issues are also impacting daily life for doctors.  In general, it takes much longer to input data into the system than it would a normal written record.  Doctors also worry that having their patients input their information into computer systems, rather than through discussions with doctors, could weaken interpersonal relationships between doctors and their patients.

Even in places where EHR implementation appears to be succeeding, like Massachusetts (which boasts over 80% acceptance among physician practices), other issues such as a multitude of EHR programs being available – and thus no standardization across healthcare providers – causes frustrations.  One healthcare provider noted a setup cost of $84,000 for their EHR system and related IT systems.  Some improvements are happening naturally.  In Massachusetts for example, 80% of healthcare providers are using one of seven EHR programs whereas before, there were as many as twenty.  Hopefully as the GAO report suggests, as the meaningful use program moves into the third phase in the coming years, interoperability becomes more of a focus.

Election 2016 and the Fate of the Affordable Care Act

As the 2016 presidential race looms on, candidates, on both sides of the isle, have provided prospective voters with ideas of how health care in America will fair under their presidency. Candidates have adopted policies ranging from complete and utter repeal of every provision of the Affordable Care Act (ACA) to proposed single payer systems. Depending on the outcome this coming November, Americans may see an end to the insurance exchange or changes to established programs like Medicaid and Medicare. Below are brief summaries of Senator Sanders and Senator Cruz’s proposed health plans.

Senator Bernie Sanders: Senator Sanders’ health plan, Medicare For All: Leaving No One Behind, would provide health care coverage to all Americans in a “federally administered single-payer health care program.” Senator Sanders projects that this plan, which would cover the breadth of health care services from preventative care, primary care services and specialty long-term care, will cost an estimated 1.38 trillion dollars a year, according to Sanders’ campaign site. The health care program would be funded primarily by a progressive tax scheme with additional funding from employers and limited premiums for certain households. Sanders suggests that his health care plan will save most Americans $5,000 and will take away the anxiety of wondering if a service is covered or if a desired health care professional is in or out of network. Naturally, there are critics to Sanders’ plan claiming that the numbers proposed by his plan are too good to be true.

Senator Ted Cruz: It seems unclear whether Senator Cruz has officially offered a full health care plan; however, what is clear is that if Ted Cruz is elected president he will not rest until the ACA is repealed. Questioned about his health care plan in a recent Republic national debate, Ted Cruz highlighted three principles that would stand as the cornerstone of his perspective plan: 1) allowing citizens to purchase insurance across state lines; 2) expanding health savings accounts; and 3) severing health insurance from employment, making health insurance individualized and portable. During his debate response, Cruz did not indicate the costs his plan or proposed initiatives carry. Moreover, according to Slate.com, what was more noticeably missing from Cruz’s response was “[a]ny mention whatsoever of how patients with pre-existing conditions, who were routinely denied coverage by insurance companies prior to health reform, would be taken care of.” While removing restrictions of where Americans can purchase health insurance seems practicable; however, as of yet, Cruz has not mentioned how he would deal with the uninsured, underinsured or individuals that explicitly receive coverage because of the ACA. Critics to Cruz’s outlined principles seem to focus on the oversight mentioned by Slate.com, that Cruz’s “plan” does not account for many sectors of the population that the ACA specifically helped.

As the 2016 presidential race is sure to heat up in the coming months, it will be interesting to see how all the candidates plan to change America’s healthcare system.

On February 3, 2016, a panel consisting of elite scientists and bioethicists gave its approval to “go forward with caution” with a form of genetic engineering called Mitochondrial Replacement Therapy (“MRT”) as long as the process is carefully monitored and closely regulated.

The purpose of MRT is to prevent the passage or development of congenital diseases by using DNA from three parents. It would use a third party’s DNA to cut out the risk of certain disorders being passed on from parent to child by replacing the mother’s damaged mitochondrial DNA with healthy mitochondrial DNA of a donor. The ultimate goal is that parents can have healthy children that are genetically their own.

Although the panel did urge that the use of MRT be limited to male embryos because “the implications of a child growing up with donor mitochondrial DNA are not yet clear.” The panel argues that it is important to limit MRT’s use to males only, because males do not pass down mitochondrial DNA to their children. Since males do not pass mitochondrial DNA to their children it would prevent modified DNA from being passed down to multiple generations, which is incredibly important since the long term impact of modified DNA is still unknown. The Panel cautioned that the procedure should only be extended to female embryos once the long term effects are better understood. However, this decision differs from the United Kingdom’s approval of the technique in 2015 and its decision not to place any sex-based restrictions on the use of MRT.

The decision came from a committee that was created at the request of the Food and Drug Administration (“FDA”) to investigate the ethical implications of three-parent babies. First, there is a serious amount of concern that babies born as a result of MRT could have germline changes, which could be passed down for multiple generations. It also magnifies the slightest lab mistake into a problem that could be faced by people for decades to come. There is also a major concern about this technology being a tool to “play god,” which strengthens the argument for significant restrictions and regulations. Additionally, the technology poses several safety and regulation concerns.

However, this approval has hit the ultimate roadblock- the Congressional wall. The omnibus fiscal 2016 budget bill passed last year contained language that prohibits the government from using any federal funds to handle applications for experiments “in which a human embryo is intentionally created or modified to include a heritable genetic modification.” Therefore, the FDA is paralyzed and unable to move forward with MRT. As a result of this restriction families that could seriously benefit from MRT will not be able to take advantage of the technology anytime soon.

By: Karina Velez

Zika virus is a mosquito-borne disease currently spreading throughout Central and South America. Since March 2014, 14 countries and territories of the Americas reported cases of Zika infection. People with Zika infection usually suffer from fever, skin rash, muscle and joint pain, malaise, headache, and conjunctivitis. These symptoms usually last less than one week and are mild. Four out of five people with Zika virus have no symptoms, according to the World Health Organization (WHO). Most cases of Zika infection require no specific treatment, but a growing concern is the effect of Zika virus on pregnant women and their newborn babies. In November 2015, the Ministry of Health of Brazil noted a marked increase in microcephaly (in which the head circumference of newborns is smaller than expected) that coincided with Zika virus circulation in the country. Zika virus is affecting multiple counties in Latin America. The number of Zika cases among travelers visiting or returning to the United States will likely increase and the virus is expected to spread to North America. Currently, affected regions are advising women to avoid getting pregnant due to the link to birth defects. Additionally, pregnant women are being advised not to travel to affected areas. Experts say that Zika may rise to the level of a global threat because there is no vaccine or treatment available.

Preventative measures that people in affected areas can take include avoiding mosquito bites by using Environmental Protection Agency (EPA)-registered insect repellant (which are all evaluated for effectiveness); wearing long-sleeved shirts and long pants; staying in places with air conditioning or that use window and door screens to keep mosquitoes outside; and sleeping under a mosquito bed net. In the upcoming weeks, WHO and other organizations will monitor the development of the virus. WHO is concerned that this year’s El Nino could cause the virus to spread further through an increase in mosquito populations. El Nino typically brings warmer temperatures and shifting precipitation patterns, creating ideal breeding conditions for mosquito populations to thrive in. Reduction of standing water is necessary to interrupt the mosquito breeding patterns.

WHO could declare a global emergency when it meets on Monday, Feb 1st 2016. If WHO makes such a declaration, it will essentially be issuing a “a global Amber Alert for public health,” as stated by Susan Kim, a deputy director of Georgetown University’s O’Neill Institute for National and Global Health Law in Washington. This declaration will shine a light on the virus and generate a worldwide response. This is a sensitive matter for WHO because it has only issued global emergencies during three other health endemics: the H1N1 swine flu in 2009, the Ebola outbreak in 2014, and the reappearance of polio in Syria and other countries in 2014. WHO officials want to make sure that nations don’t take inappropriate steps to limit travel or trade because of the virus, said Bruce Aylward, assistant director-general of the WHO. Nonetheless, a strong response erring on the side of precaution is necessary because this virus is an inchoate infection and we have very little knowledge about it. Individuals are being exposed to it and they have no immunity to the infection and therefore more unknown affects and symptoms may arise and cause a serious pandemic.

By: Alexandra McLeod

Recently, an influential government appointed panel solicited by Human and Health Services (HHS) gave screening for postpartum depression during and after pregnancy a “B” rating in the Journal of the American Medical Association.  This new rating, if accepted, means that the Affordable Care Act would have to cover the screening of mothers during and after pregnancy for depression. As research has developed about this issue it has been found that postpartum depression can occur during pregnancy and if left untreated the mood disorder can negatively impact the child. Some individuals are curious as to why depression may occur in expectant mothers and the answer to that question is still unclear. The postpartum depression may stem from a mother not being able to bond with her child during or after birth or it is sometimes found to be genetic. In more recent years, research demonstrated more mothers suffer from postpartum depression after giving birth to their children. It is said that one of every seven mothers experiences the feeling of depression and only more recently have these mothers felt comfortable to talk to their doctors about these concerns.

Several healthcare providers (ex: obstetricians) have said that women have fears of hurting their children or themselves or concerns about the child’s welfare that is out of the mother’s control. This leads to mothers sometimes not being proactive with their prenatal health and if continued to go untreated a mother’s mental illness could affect the child’s well being. Previously, doctors were concerned with the risks of treating depression during pregnancy through a low dose or medication or screening because of the impact the protocols may have on the baby. However, as a result of growth within the medical field there is greater access to mental health facilities, safer ways to screen mothers for depression, and lower dosage anti-depressant medication that mothers can take that do not negatively impact the baby. It is important that women take advantage of these services to allow every mother the opportunity to play an active and positive role in her child’s life. Mayor Bill de Blasio of New York announced a goal to include universal screenings in women’s routine care.

While there is a large push to enact legislation for depression screenings during and after pregnancy the panel did not request a certain number of screenings for the expectant mothers during pregnancy and after birth to ensure that all mothers are receiving the proper care. The number of screenings can be determined upon future research and doctors’ opinions on the subject matter to protect their patients. This type of legislation is important because of the increasing number of expectant mothers that seem to be experiencing racing or suicidal thoughts. There is not better way to protect these women than being proactive and making sure the care that expectant mothers need is provided for these women through the new Affordable Care Act. A strong and loving motherly influence is important in a child’s life and the new depression screening guidelines will help make this possible.

In April 2015, the Kansas State Legislature passed the Kansas Unborn Child Protection from Dismemberment Abortion Act. This law, with few exceptions, would ban “dilation and evacuation” abortions, or “D&E” abortions. These abortions are the primary method for second-trimester abortions in the United States. These abortions are common and considered the safest option for a second-trimester abortion. Kansas became the first state to ban this procedure.

Weeks before the law was to take effect last summer, three doctors filed a lawsuit over the bill. The key issue was whether the Kansas Constitution provides a right to abortion. In January 2016, an evenly divided Court of Appeals blocked this law, stating that the rights of due process and equal protection protect the procedure. The court, citing Roe v. Wade, further stated that the United States Constitution has protected the right to an abortion for over 40 years. The court affirmed the lower court’s injunction. The case is now going to be reviewed by the Kansas Supreme Court.

The appellate court’s opinion offers both sides of the issue. It states that the “rights of Kansas women are not limited to those specifically intended by the men who drafter our state’s constitution in 1859.” The other side states, “there is nothing within the text or history…the Kansas Constitution Bill of Rights to lead this court to conclude that these provisions were intended to guarantee a right to abortion.”

Opponents of the bill point to the fact that medical science supports this procedure as the safest option, and that to override science is “astonishing.” Furthermore, if this law were to move forward, there would be no alternative for women who seek this procedure.

Supporters of the bill focus on the graphic nature of its title. They argue that proponents of the procedure purposely use terminology that the public can’t understand. In explaining this, they analogize it to a doctor who wouldn’t say, “we’re going to disarticulate your limb. He’s going to say, we’re going to have to break this bone and reset it.”

This case will be widely watched for the effect that it will have on women throughout Kansas, and potentially in other states. This law would place an undue burden on women seeking to exercise their right to this procedure, which the United States Supreme Court also stated was unconstitutional in Stenberg v. Carhart. The Kansas Court of Appeals appropriately protected cited the rights to due process and equal protection for the women in Kansas.