December 22, 2014

Health disparities and Electronic Medical Records

I have been thinking in my personal life about electronic medical records (EMR.) A number of friends are doctors who service multiple hospitals, and they sometimes encounter different systems at each hospital (if the hospitals even have electronic medical records.)

As a privacy advocate, it might be weird for me to be advocating electronic medical records because of the potential hazards, but as a patient, it is much, much easier to have continuity of care with EMR. I don’t have to drag a paper printout of my test results with me to each new doctor. When I was insured via Kaiser, it literally took minutes from the time I walked from my doctor down to the pharmacy below for my prescription to be filled. The doctor had ordered the Rx while I was with her, and sent it electronically. It was truly a beautiful streamlined feat that I still wonder at. Like pressing the Staples “Easy” button.

Not being a medical professional, I don’t have to worry if I’m repeating back the precise medical jargon that was fed to me before. For patients who have limited English proficiency (LEP), it is easier than having family members serve as sometimes imperfect translators each and every visit. This doesn’t negate the need for each doctor or specialist to ask questions, but it can be helpful for establishing and cross-checking prior medical history. And it’s important for EMRs to be tailored to specific communities – recommendations for best practices are outlined by HHS and Partnership for Women and Families.

Obviously, having a nationwide EMR system exposes a ridiculous amount of HIPAA data to hackers, and there would have to be the most stringent measures taken to protect patient safety. However, there are already certain nationwide EMR systems such as the one used by the Department of Veterans’ Affairs, which was one of the early adopters of EMR. Despite some of the ways in which the VA is currently broken, the agency deserves kudos on this count. Doctors actually point to the VA EMR system as a model of efficiency even compared to systems at top university hospitals. (That the VA system and the Department of Defense systems don’t talk to each other is a whole other story.)

The same way that I can get a prescription filled in different cities because my information and insurance is in the system, it would be great if not only veterans, but all Americans, could see healthcare practitioners who understand their medical histories without having to wait for the home institution or doctor’s office to fax over information.

I could even see a system that has translations of diseases, causes, symptoms, and treatments that a patient could look over. This isn’t perfect because not all patients are necessarily literate in their native languages, but it could help to overcome some of the barriers. Obviously we still want more culturally and linguistically competent providers and translators at hospitals, but this is a way of bridging the divide. We can make tech work to increase voter participation and allow people to cast ballots in their native languages, why not to improve health outcomes?

–Caroline

Dr. Danielle Martin schools Sen. Richard Burr

My homeland of Taiwan has a single payer healthcare system which is famed for its affordability and Western levels of care and service. Canada also, though conservatives want to market their for-profit healthcare systems as superior to all the rest of the world. You’ve already heard the stats about how behind the US is for overall health and GOP hardheads spew the stereotypes which are ridiculous to everyone else, but here’s something to make you smile.

Dr. Danielle Martin schools Sen. Richard Burr (R-NC) on national healthcare. Dozens of articles repeat the delicious exchange. For audio, see “Canadian doctor schools U.S. Senator on public health care“.

I could go on & on abut how conservatives are paid off by healthcare and pharmaceutical lobbyists but worse than legalized corruption is how Americans are too lazy to lobby their representatives (thus lobbyists work) & won’t want to change the system until they’ve a $10,000 doctor’s bill. And even then, they’re too lazy to do much other than fight a menial fight with the insurer. Don’t be that person.

Question of the Week: Medical Marijuana

Should it be legal for people in chronic pain to use marijuana?  Please share your thoughts below.

— Gautam Dutta

In Mike We Trust

Ed. note This Op-Ed by Kal Penn appeared in the May 10 edition of India Abroad

I first worked with Congressman Mike Honda when I was a White House aide to President Obama, working on issues related to young Americans and the Asian American and Pacific Islander community. In a sea of chaos that is Congress, it was always refreshing to see Mike go to bat for his constituents, and to join the President in standing up for young people and community members in a way that most members of Congress did not.

Having worked alongside Mike in both policy and politics, I am proud to endorse him for his re-election to Congress in 2014. Washington, DC, can be sort of a crazy place. To many of us, it’s unfathomable that there is opposition to commonsense issues like access to health care, comprehensive immigration reform, and education. And we often look to our leaders to see how they intend to engage on those issues we care about.

As the Congressman representing the innovative spirit and drive of Silicon Valley, as chair of the Congressional Asian Pacific American Caucus for an unprecedented seven years, and now as chair emeritus; as a member of the powerful Appropriations Committee, it’s rare and refreshing that Mike really moves and lives by the conviction that every one of us deserve an opportunity and a voice.

As a young person, that kind of leadership was refreshing to see.

On health care, Mike and CAPAC worked with the Congressional Black and Hispanic caucuses to include critical provisions that tackled health disparities in the President’s final historic health- care reform legislation of 2009.

On immigration, over the previous three Congresses as chair, and now as chair of CAPAC’s Immigration Task Force, Mike has led the constant drumbeat to pass a comprehensive immigration reform that leaves no one behind. He believes in an immigration system that is inclusive, family- based and humane, and invests in America’s future.

On education, he worked to dispel the model minority myth, and to push for greater resources flowing to colleges and universities that serve underserved Asian American and Pacific Islander students.

Mike’s record speaks volumes to his character. He has continued to push for issues that are critical, regardless of whether there is existing political appetite for it amongst his peers in Congress; essentially, he has helped to create the tenable space for much of the action we have seen.

His advocacy for social justice and serving communities that do not have a voice is unparalleled. Mike grew up behind barbed wire in a Japanese-American internment camp, even as his father served in the United States Military Intelligence Service during World War II.

As a young boy, he learned that being Japanese carried a negative connotation in America. But he knows that the reason Japanese Americans were unjustly and illtreated was because no one in Washington said no.

Today, Mike continues to be an unwavering opponent of hate speech and bullying perpetrated against all communities, regardless of creed, race, gender, sexuality, disability, country of origin, and immigration status.

Mike has been a friend and mentor to many young leaders, artists, business folks, and innovators. I know that he will continue to deliver that which is just and best for his constituents and for this nation.

– Kal Penn

Public hospitals in NYC charge less for Medicaid care than private, hospital closings & the safety net

The NYTimes has a new article out on the discrepancy amongst hospitals and what they charge for Medicaid procedures. This isn’t a new topic (Stephen Brill did a great piece on it called “Bitter Pill” and patient advocates have known this for a long time), but the government released new comparison data on 3,000 hospitals nationally. In the NYC area, it’s unsurprising – the public Health & Hospitals Corporation (HHC) hospitals charge less than the US average for Medicaid services. The private hospitals charge anywhere from 1-2 times the US average, to more than that. Unsurprisingly, because the public safety net hospitals try not to gouge their patients, their finances are also suffering. Of the hospitals that have closed or that are on the chopping block, many are HHC hospitals.

Some of the hospitals that charge less than the US average: Bellevue, King’s County, Harlem, Downtown, Elmhurst, Flushing
Some that charge 1-2x the US avg: NYU Medical Centers, NY Presbyterian, St. Luke’s-Roosevelt, Beth Israel, UMDNJ
Some that charge > 1-2x US avg: Robert Wood Johnson Rahway, Long Island Jewish

Let’s have a conversation about what hospitals price gouge versus perform a public service the next time the state decides to put together Berger Commission part 2 to close hospitals. Because that analysis was incredibly short-sighted and determined that there were too many hospital beds in the event of an emergency. Of course, they thought we would still have access to all bridges and tunnels in the event of an emergency. So when Hurricane Sandy hit, Manhattan hospitals had to transfer within the island. But there weren’t enough beds to transfer patients to, so it took longer to remove all the patients from the waterlogged hospitals. I would hope that this is a serious consideration the next time around.

It’s easy to make money by overcharging. It’s harder to keep hospitals afloat when you are committed to public service, harder to justify grossly overcharging for things from basic bandages to complicated, costly procedures.

–Caroline

It Takes A Village To Blow One Up

West, Texas was best known as a place to grab something from the Czech Bakery while driving between Austin and the Dallas-Fort Worth Metroplex. Now, West is best known as the latest in a long line of American industrial disasters reprehensible for their utter preventability.

The explosion at the fertilizer plant comes from failure of the local, state, and federals governments and the plant owners and operators to satisfy the needs of worker safety, community safety, and national security. OSHA has not inspected the plant since 1985. Schools and homes were allowed to be built very near the plant. The plant had 1,350 times the amount of ammonium nitrate at which Department of Homeland Security regulation is triggered. We know the plant had so much ammonium nitrate, because paperwork indicating such was filed with with a Texas regulatory entity. The mishmash of regulators is not required to share information. Unlike the inability of first responders to communicate with each other because of technical incompatibilities, government regulators don’t interact with each other. Given the large variety of regulating agencies, better intercommunication is needed.

A tangle of agencies regulates plants like the one in West. Different agencies were assigned oversight for different chemicals there. Among the federal agencies responsible were the E.P.A., Homeland Security, the Occupational Safety and Health Administration and the Pipeline and Hazardous Materials Safety Administration. State agencies include the Texas Commission on Environmental Quality, the state chemist’s office and the state health services department.

Ammonium nitrate is a national security concern because in nefarious hands it can cause this:

Murrah_Building_-_Aerial

Terrorism isn’t the only reason for concern about the large amount of such an explosive chemical:

The explosion was so powerful it leveled homes and left a crater 93 feet wide and 10 feet deep. Judging by the size of the crater and the extent of the damage — pieces of twisted metal landed in distant pastures, and ceiling tiles and lights shook loose in buildings two miles away — the explosion was more powerful than the Oklahoma City bombing, experts said.

Texas markets its lax regulations as a reason for businesses to relocate:

Loose regulations” in Texas may be a nice pitch for out-of-state business, however, in 2010 the state accounted for 10% of all workplace-related fatalities in the country. In 2011, Texas had the second-highest number of fatality investigations from OSHA (California was first), in 2010, Texas led the nation in Latino worker fatalities.

The marvelous economic tales spun about Texas even beguile those who should know better like a writer for Texas Monthly. Jack Ohman and the editors of the Sacramento Bee, however, were not beguiled:

RTSHf.St.4

The owners and operators of the plant seem to have long thought they could pick and choose what few regulations with which they were supposed to comply would apply to them. Among other problems, the company received a citation for construction of 6,000 gallon ammonia tanks without a permit, did not have a sufficient risk management plan, and had no signs or illegible signs on many storage tanks, many of which did not meet safety standards.

The Czech connection in West remains strong; the Czech Republic may provide nearly $200,000 to aid recovery. That’s very helpful and kind; it’s greatly appreciated. I wonder, though, if Bangladesh provides something even better, a guide on how to handle preventable disasters — arrest the owners.

How many other extremely dangerous plants and chemical storage facilities continue to operate in similar fashion with such disregard for the workers, the community, and national security?

– Justin Gillenwater

White House Initiative On Asian Americans & Pacific Islanders Comes To Houston On February 23

On Saturday, February 23rd, the Texas Asian American & Pacific Islander community and the White House Initiative on Asian Americans & Pacific Islanders invite you to attend the Texas Regional Conference at the University of Houston‘s main campus. This free, first-of-its-kind conference will be a unique and valuable opportunity for the Texas AAPI community to interface with the White House and federal agencies to learn about federal programs and potential policy developments, leverage resources, develop solutions to address AAPI concerns, and bring together people from all across Texas together to collaborate on empowering our community.

In addition to connecting with federal resources, this is an opportunity for community members and leaders throughout the entire state to gather in one place and discuss ways to collaborate, share resources, and maintain communication.

The morning will feature speakers including Kiran Ahuja, the Executive Director of the White House Initiative on Asian Americans & Pacific Islanders, and a keynote from Chris Lu, Cabinet Secretary and Special Adviser to President Obama. Lunch will be provided (vegetarian options included), followed by breakout sessions addressing specific topics, including Economic Development, Healthcare, Civil Rights, Immigration, Education, Housing, Senior Issues (Social Security, Medicare, housing, etc.), Labor/Employment, and more. These breakout sessions will feature staff from local federal agency offices that can help directly address specific issues or problems, as well as featured local speakers from the community. The agencies will also provide information on federal job and internship opportunities for students.

Participation is free and open, but online registration is required.

Question of the Week: Gun Control

If we need to pass a “background check” to get on a plane, why shouldn’t we have background checks for people who are buying ammo for a gun?

— Gautam Dutta

Sam Yoon To Lead Council Of Korean Americans

I wanted to share an update on what has been happening since you joined me in our historic campaign for mayor of Boston in 2009.

Several months after the election I made the difficult decision to leave Boston and move to the Washington, D.C. area. Though I loved Boston dearly, I took the opportunity to move closer to my family, but also to lead a national organization advocating for community economic development.

I learned so much about how grassroots community organizations all around our country both thrived and struggled due to the Great Recession. I took their message to our national leaders and even documented them in our own YouTube channel. But by the end of 2011, I was offered a chance to serve in the Obama administration.

Most of you know I was an early and strong supporter of Barack Obama in his historic 2008 race, and I was honored to work for him during most of this year at the Department of Labor in the Employment and Training Administration (ETA) as a senior policy advisor. The time I spent there was both eye-opening and sobering. It is an enormous challenge to prepare a 21st century workforce in a struggling economy with a gridlocked Congress. Yet I saw the good people at ETA march on every day, for American workers, and I salute them.

This brings us to today. I am pleased to let you know through this email that I have recently been hired as the President of a non-profit organization called the Council of Korean Americans (CKA). CKA is a national, non-partisan group of Korean Americans whose mission is to assert a clear, strong voice on matters of importance to our community and to advocate for our full participation in all aspects of American life.

Founded in 2010, CKA fulfills a clear need in the Korean American community, which, like many immigrant and ethnic communities, lacks a national, unified voice. I firmly believe our members and our allies have the talent, energy, and drive to make this happen. I would love for you to be involved.

Check back from time to time at our website. I plan to start a blog and comment on issues of the day from a more personal point of view. I encourage you to sign up for our newsletter and stay in touch with me as I take on this new venture.

That’s my update, in two minutes or less! Thank you for reading, and thank you so much for your friendship over the years.

Please stay in touch, and God bless!

– Sam Yoon

The 2012 DNC AAPI Caucus

The second AAPI caucus meeting was well-attended and filled with remarks from a number of Asian American politicians, several Secretaries, and one Second Lady. I wish I could say the same for the first meeting, but I wasn’t there. It was over by the time I picked up my media credentials. Lesson learned.

Congresswoman Judy Chu, Chair of CAPAC, reminded everyone in the room that President Obama is good for our community, and I don’t just mean Asian Americans. Delegate Madeleine Bordallo of Guam reminded us President Obama grew up an island boy — he doesn’t forget about the territories. Perhaps the key takeaway from Chu’s remarks, Republicans are working so hard to prevent those who wish to register to vote from doing so — 81% of first time voters voted for Obama in 2008. Congressman Honda, former chair of CAPAC, rightfully declared Asian Americans the theoretical margin of victory, but only if we register to vote. Only 55% of eligible Asian Americans are registered.

Chu also focused on the anti-Asian sentiments percolating throughout unsavory elements of the American polity with particular focus on Pete Hoekstra bringing in yellowgirl in Michigan in the year of the 30th anniversary of Vincent Chin’s murder.

Chris Lu, President Obama’s Cabinet Secretary, noted that 2012 is not only the 30th anniversary of Vincent Chin’s murder but also the 70th anniversary of the Japanese Internment and 130th anniversary of the Chinese Exclusion Act. Lu also reminded us that before President Obama, a meeting of every Asian American Secretary throughout history would fit at a table for 2. Now if they all got together, there are many board games they wouldn’t be able to play together since Obama appointed the third, fourth, and fifth Asian American Secretaries.

Secretary Arne Duncan gave some of the best news of the caucus — the Department of Education is working to dispel the model minority myth. Duncan also shared that this was his first convention and he’s having a great time. There’s always something special about one’s first. Duncan stressed the importance of America leading the world in college graduation; the Department of Education is working to make that happen.

Secretary Hilda Solis reflected the feelings of many, many people. The Democratic National Convention looks like America, unlike the Republican National Convention. Solis also celebrated AAPI politicians and leaders, whom she collectively referred to as “fast and effective.” Solis’s words also included high praise for Michelle Obama.

Tina Tchen, Michelle Obama’s Chief of Staff, also praised the First Lady, noting how critical her work on childhood obesity is to many AAPI communities. Tchen reminded the crowd that 17 new Asian American federal judges have been appointed and confirmed thanks to President Obama with 3 more on track for confirmation.

Former White House Chief of Staff Pete Rouse expanded on the theme of federal judges, making the point Gautam says is ignored in this presidential race — 2 SCOTUS nominations could arise in the next presidential term. Rouse also urged everyone in the room to make their best efforts to maximize turnout.

Dr. Jill Biden appeared for a few brief remarks largely stressing the importance of involvement in the political process.

Maya Soetoro-Ng also spoke.

Daniel Inouye gave a speech that should have been televised.

Mayor Ed Lee was the most amusing speaker, upstaging Mike Honda, who usually has no competition for most amusing:

I’ll be short because I am.

On a personal note, I don’t know if anyone in the room needed or made use of it, but I greatly appreciate the accessibility provided to the hard-of-hearing:

– Justin Gillenwater