We, as a nation, are at a critical moment in regard to health information technology (HIT). HIT has become a primary part of President Obama’s health care reform plan, and there is a significant investment for HIT in the American Recovery and Reinvestment Act of 2009. It is our responsibility to help ensure that the right technology is developed and deployed to achieve the goals of the Administration, namely increased patient safety, improved clinical outcomes, and decreased costs.

During 2006 and 2007, the American Academy of Nursing’s (www.aannet.org) Workforce Commission conducted a study, “Technology Solutions to Make Patient Care Safer and More Efficient.” The data collection engaged interdisciplinary teams of healthcare providers at 25 hospitals across the country to review their normal workflow practices with the aim of assessing how technology could improve the work environment. The study found that while the use of technology has become more common in health care, it has not been designed and adopted in a way that reaches its full potential. Much of the current information system software and many of the devices and equipment systems actually add to the complexity of work environments and take nurses away from their critical responsibility of patient observation and early intervention. The study findings support the need for technology interoperability, point of care devices and workflow analysis to address the efficiency and training issues identified by over one thousand nurses and other clinicians.

Consequently, the Academy concludes that nurses and other direct care providers must be involved in the design and testing of new and innovative applications and devices so that the technology available to the field is both user-friendly and affordable. Involving nurses as end-users in the early stages of system analysis and design can lead to better adoption of new technology, as well as identifying how current technology can be changed in order to achieve increased efficiency and greater user acceptance.

This research illuminates the importance of manufacturers developing and hospitals purchasing technologies that support the work of nurses and other direct care providers. It is not just the implementation of HIT, but rather the implementation of the right technologies that will enable health care practitioners to have more time with their patients. This, in turn, will lead to increased patient safety, improved clinical outcomes, and a reduction in costs.

A friend and colleague of mine recently sent me a copy of a journal entry that his daughter and a friend wrote while traveling in Africa. Liana Sideli and Liza Reynolds, both 22, are recent graduates of Middlebury College. These remarkable young women are independent (not affiliated with any organization) volunteers, spending several weeks at St. John Bosco Rehabilitation Centre in Kenya.

It is an incredibly moving description of their experiences in Kenya, including a trip they made to accompany a child who was going to see a group of American doctors in the hopes of having another operation he needed to repair injuries he sustained when he was very young. It is an amazing story and one that I think will help to remind us how fortunate we are to have such readily available access to health care when for so many others, it is truly a luxury.

How do we even begin…

We’ve been here in Kitale, Kenya for 6 days and we’re having the time of our lives. After some minor air travel complications which left Liana stuck in London and put Liza on a plane landing in Kenya by herself, we were finally reunited 48 hours later and haven’t left each other’s side since. We’re volunteering at St John Bosco Children’s
Rehabilitation Center (“Bosco”). The center is for poor children who have either been left on the street or come from broken families, but most aren’t orphans. Foster parents don’t exist here because tribes don’t accept other tribes’ children, so often these kids are left hungry, neglected and uneducated. Kenyans put a huge emphasis on education which is why there are so many childrens homes and schools in this area.

On our first day, we got a brief tour of the 3 acre compound and met the staff who are all very friendly and welcoming. It’s pretty quiet during the day because most of the children go to the local primary school, and only the 7 year olds (the new students) are taught at Bosco – this is their first time in a classroom and they are being prepared to go to the local primary school in a year or two. We were just walking around outside and all of a sudden eleven tiny people came running out of their classroom to go play, and they were stopped dead in their tracks at the sight of two big, tall white girls with giant smiles standing there in front of them. They were very shy at first, but they have grown much more comfortable, talkative and affectionate with us over the past week.

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On March 18th I represented the American Academy of Nursing (www.aannet.org) at The Women’s’ High-Tech Coalition Luncheon that took place on Capitol Hill. The title of the Panel was Health Information Technology: Addressing Privacy and Security Concerns to Bring Healthcare into the 21st Century. The other panelists were: Kate Gross from Senator Jay Rockefeller’s office, Lisa Gallagher from HIMSS and Eva Powell, Health IT Director for the National Partnership for Women and Families. With all the momentum around Health IT I was pleased to have this opportunity to participate in this important discussion and present the nursing perspective.

Here are the thoughts I shared…

1. The Academy is supportive of the investment in smart health IT as it has the potential to be a useful tool that can assist patients, families and health professionals in reducing errors, improving care coordination, patient safety, quality and outcomes. However, we want to ensure there is discussion surrounding how to sustain the technology so it can continue to meet both patient and provider needs happens during the initial implementation stages.

2. We believe there needs to be a balance between privacy and the realities of health practice and the need to share timely information.

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Women and girls turn to domestic work as one of the few options available to them in order to provide for themselves and their families. Instead of guaranteeing their ability to work with dignity and free of violence, governments have systematically denied them key labor protections extended to other workers. Domestic workers, often making extraordinary sacrifices to support their families, are among the most exploited and abused workers in the world.

In New York State, there are 200,000 nannies, housekeepers and eldercare workers. They provide primary care including healthcare to many people. Virtually all of them are immigrants, the vast majority of them undocumented, and mostly women of color – which makes it all too easy for employers to exploit them, wittingly or not. Workers usually achieve rights through strength in numbers, but when you work in 200,000 places it’s hard to organize. They have never been protected by state labor laws. Things are getting worse. Labor advocacy groups are hearing from household workers that abuses are increasing as their employers face strain in their own lives. Increased violence, lay-offs, unjust firings or wage cuts and workers given additional responsibilities for the same pay.

Abuses against domestic workers, in private homes and hidden from the public eye, includes physical, psychological, and sexual abuse. In the worst situations, women and girls are trapped in situations of forced labor or have been trafficked into forced domestic work in conditions akin to slavery.

In New York State, both the Assembly and Senate Labor Committees have passed the Domestic Workers Bill of Rights out of committee. It’s up to the New York State legislature now to pass the Domestic Workers Bill of Rights (A1470/S2311).

The New York Domestic Workers Bill of Rights is the first legislation of its kind nationally and will set a precedent for labor standards for domestic workers around the country. Contact Domestic Workers United at http://www.domesticworkersunited.org and help make this happen in NYS so other states can follow in legislating laws to protect the millions of domestic workers nationally.

The following article, written by Karen Sampson, originally appeared on the Masters in Health Care blog.

Barack Obama’s American Recovery and Reinvestment Act of 2009 was signed on February 17, and is already beginning to filter out funds to hopefully stimulate the economy. One of the principal goals of the package is to reform the health care system while creating jobs and insuring more Americans. Through measures to support the unemployed, integrate cutting-edge information technology systems into medical networks, and insuring more children, the act may in some way affect how you receive health care. Find out how.

1. Health care industry set to go tech: One of Obama’s umbrella strategies for reforming health care and stimulating the economy involves pumping money into health care technology systems. He hopes to create a health information network for hospitals, rural and urban clinics, and other health care centers by making all medical records electronic; making existing medical technologies more accurate and effective; and reducing errors in medical care. This technology boost to the health care system will, Obama hopes, save money, create jobs, and improve the standards and delivery of health care and medical information. The Dallas Business Journal reports that the stimulus package will invest $19 billion for health information technology.
2. The unemployed will still receive health care benefits, at least temporarily: Obama plans to ease the burden of health care costs for the unemployed and reduce the number of uninsured Americans by extending Medicaid benefits to the unemployed, at least for a time. Individuals who get unemployment checks would also be able to receive Medicaid, as would their spouses and children who are under the age of 19, reported the New York Times in January. States will receive federal aid to help ease Medicaid costs. In late February 2009, TheState.comreported that Obama “released $15 billion in economic stimulus Medicaid funds for states” to disperse. (more…)

I am not usually one to take on the Vatican. In fact, I toured its lovely treasure-filled buildings only three months ago and marveled at the wealth and power it denoted. However, the Pope’s recent pronouncements during his travels in Africa that condoms and abortions are morally wrong have filled me with righteous indignation. I too have spent time in Africa. But I wasn’t there to make pronouncements from on high. I was there to make a documentary about the increasing number of married women with AIDS in Kenya. I walked through Kibera slum and watched large families crammed into corrugated metal sheds without plumbing or heat.

Even so, I probably wouldn’t take on the Pope…except for an article in today’s Washington Post. Apparently, the Vatican’s top bioethics official said the two Brazilian doctors who performed an abortion on a nine-year-old rape victim “did not merit excommunication, because they acted to save her life.” HELLO! In my book, that’s called a pro-choice stand. Bravo for Archbishop Rino Fisichella, president of the Pontifical Academy for Life. Perhaps he should have a chat with his boss.

Abortion is not a black and white issue for me, despite having worked for the better part of a decade for Planned Parenthood Federation of America and NARAL on reproductive health issues. That’s why the pro-choice position has also seemed to me to be the reasoned one. It allows individuals to make decisions and encourages each of us to define for ourselves what is reasonable and acceptable. There is a trust factor in being pro-choice. For example, if there is the possibility that a nine-year-old may be raped by her stepfather, you want to believe that the pregnancy will be ended as swiftly and humanely as possible.

Good for Archbishop Fisichella for being able to see that issues related to reproductive health have gray areas! And that it is often possible to be both pro-life and pro-choice while having to accept difficult decisions. Is it too much to hope that Pope Benedict XVI might also see the light? If he truly listens to the people of Africa and other continents, and opens his eyes to their hopes for their own lives – I have faith that he may begin to understand the healing power of condoms and the life-affirming necessity for legal, safe abortions.

The Boston Globe reported this morning that President Obama has chosen David Blumenthal, MD as National Coordinator for Health Information Technology at HHS. Dr. Blumenthal, who will replace current ONC Robert Kolodner, is a “Harvard Medical professor who is director of the Institute for Health Policy at Massachusetts General Hospital.” From the Globe’e Political Intelligence blog:

In his new post, he will be in charge of nearly $20 billion in the economic stimulus package to build health IT, including encouraging more doctors and hospitals to use computers.

Also among Blumenthal’s responsibilities, Healthcare IT News reported:

Blumenthal will lead the implementation of a nationwide, interoperable, privacy-protected health information technology infrastructure, as called for in the American Recovery and Reinvestment Act…

For more on Blumenthal, check out his National Journal Health Care Experts blog biography, and for more about his future position at HHS, see the HHS News Release.

Reacting to the news, Life as a Healthcare CIO blogged: (more…)

Dr. Troy Robbin Hailparn was interviewed by Disruptive Women’s Wendy Grossman.

Dr. Troy Robbin Hailparn, is board certified in obstetrics and gynecology by the American College of Obstetricians and Gynecology. She received her BA in Psychology from Barnard College of Columbia University and her MD with distinction in Reproductive Endocrinology from the Albert Einstein College of Medicine.

At the end of this post, you will find not one, but two polls. We hope you will respond to these and share your opinions.

Gynecological surgeon Dr. Troy Robbin Hailparn thinks the labia is the most ignored female body part.

She was the first female physician trained to perform laser vaginal rejuvenation, labiaplasty and the very controversial hymenoplasty.

In 2007, the American College of Obstetrics and Gynecology released a committee opinion against vaginal rejuvenation.

Dr. Hailparn wants to change their mind.

At the May annual clinical meeting, Dr. Hailparn plans to present her 500 labiaplasty patients, and the 11 reasons she’s discovered women have the surgery. Of those women only 70 out of 500 had the procedure for cosmetic reasons.

“Everybody thinks it’s a cosmetic procedure,” Hailparn tells Disruptive Women. “It’s not. People think it’s like genital mutilation. It’s not.”

Dr. Hailparn took the time to talk to Disruptive Women about why the work she does is so important to so many women and should be endorsed by ACOG and covered by health insurance.

DW: So, what are the reasons you’ve found that women have labiaplasty?

TRH: The big reasons are: clothing, exercise and activities and intercourse. The labia get pulled in and out with intercourse, so that can be painful.

DW: Oh God.

TRH: Whether it’s one lip or both lips they get pulled in and out. Think about the woman who has to actually move them out of the way in a spontaneous moment because she knows and anticipates it and she has to shove them out of the way because he’s about to enter. Somebody living with this extra tissue has to accommodate. Sitting, exercising, or clothing are the big three. They can’t fit comfortably. They can’t walk because they have chronic irritation or chafing. They tuck them up to get them out of the way. They stuff them up into the vagina to get them out of the way.

DW: Oh God. (more…)

The Disruptive Women in Health Care blog is proud to have been asked to join the coalition of the Aspen Institute’s www.aspeninstitute.org newest health initiative:  The Aspen Health Stewardship Project.  We are in good company.  AARP, the Partnership for Prevention, the American Heart Association, GE Healthcare, PhRMA, the American Lung Association, Susan G. Komen for the Cure and WomenHeart are just a few of the other coalition members.

Last week, Michelle McMurry, MD, PhD, Director of the Health, Biomedical, Science and Society Program at the Aspen Institute (and a founding Disruptive Woman) held an event to release a new white paper from the Stewardship Project.  Here’s what she had to say:

The principles of the Aspen Health Stewardship Project are:

• Access is not enough.
• I am in charge of my health.
• Value and quality in care are paramount.
• Focus on cultural change.
• Health span, not life span.
• Turn information into insight.
• An effective health care system is a transparent one.
• Equity in  health, not just in health insurance.
• We shouldn’t have to tell our children that they won’t live as long as we will.
• Health in all policies.

You can learn more about this important project at http://www.aspeninstitute.org/policy-work/health-biomedical-science-society/health-stewardship-project.

It’s been a big week for health care, women, and women in health care, with significant news events such as the creation of the White House Council on Women and Girls, and Obama’s choice for FDA commissioner.

The Obama Administration has chosen former NYC health commissioner Margaret “Peggy” Hamburg to head up the FDA. The White House wants the new FDA commissioner to be “somebody who will focus the agency on its core mission of public health,” according to the Wall Street Journal. From Sarah Rubenstein’s profile of Hamburg at the WSJ Health Blog:

In New York, [Hamburg] instituted a needle-exchange program to help prevent the spread of HIV. She also set up a program, later mimicked by health departments around the world, in which health workers went to tuberculosis patients’ homes to help them manage their drug regimens.

Hamburg, a Harvard Med School grad, was an assistant secretary of health and human services during the Clinton administration and now works at the Nuclear Threat Initiative, which tries to cut the threat from nuclear, chemical, and biological weapons… Among other things, she opposed a “morality oath” demanded by the Board of Education in 1992 while the city was debating abstinence-focused sex education in schools.

On Wednesday, President Obama signed an Executive Order establishing the White House Council on Women and Girls. Valerie Jarrett will be the council Chair, with Tina Tchen as Executive Director. The official press release explains, “The mission of the Council will be to provide a coordinated federal response to the challenges confronted by women and girls to ensure that all Cabinet and Cabinet-level agencies consider how their policies and programs impact women and families.” One of the council’s main objectives is to improve women’s health care.

Watch President Obama’s announcement here:

On Essential Estrogen, Lynda provided text of Obama’s remarks, and lists of female members of Congress and representatives from advocacy groups in attendance.

On the Care2 Women’s Rights blog, Ximena R. presented a few advocacy groups’ reactions, as well as her own: (more…)

I write this post with a great deal of enthusiasm! I am pleased to announce the addition of six new contributing authors to our dynamic list of disruptive women. The new bloggers include:

• Tamar Abrams, Strategic Communications Consultant and Blogger;
• Barbara Glickstein, R.N., Producer & Host, Healthstyles
• Jennifer McCabe Gorman; Chief Patient Advocate, Organized Wisdom
• Christine Gray, Ph.D., Anthropologist and Healthcare Activist
• Phyllis Greenberger, M.S.W., President & CEO, Society for Women’s Health Research; and
• Holly Potter, Vice President, Public Relations, National Media and Stakeholder Management, Kaiser Permanente.

These accomplished women are all disruptive in their own right. Their vast experience and expertise will be invaluable to the health care discussion. I am looking forward to the unique perspective each woman will bring to the spirited dialogue already taking place on the blog. You can learn more about these extraordinary women by clicking on their bios (they are listed among our founding authors on the right).  Several have already guest posted on Disruptive Women–check out our archives. Stay tuned for more fireworks….

I just finished reading Matt Taibbi’s analysis of the state of the union, so to speak, called The Great Derangement: A Terrifying True Story of War, Politics & Religion at the Twilight of the American Empire. It is a great read, one I recommend, and forewarned, like most great reads, both unsettling and haunting. Among other analyses he provides is his descriptive narrative about how Congress “works”. Decisions are controlled by a small group of “leaders” in Congress who cut deals with interest groups so current members have enough cash (and influence) on hand, through grateful donations and reciprocated influence, to be reelected, so they can continue to do what they do. This incestuous circle, embraced by both parties, does not appear to have (as yet) been disrupted, from what I can gather.

Enter health care reform, which not surprisingly, is really health care financing reform with a nod to access. Health care as a human right does not appear to be the overriding focus so far, albeit an acknowledged catalyst for the discussion. And the arena of discourse will be the Congress. Here the confluence between Taibbi’s observations and the charge to our legislators creates a deep misgiving.

One of the most interesting first “worries” getting airtime as the process unfolds is what to do about all those young people who refuse to buy coverage, as if this were our most fundamental challenge. It reminds me of the good old days when Aid to Dependent Children was attacked because of the massive “abuse” of the system: we don’t want to pay for these folks who are not bearing their part of the great burden. In nearly all the discussions about change since the rather startling activity emerging from the Obama Presidency (it seeming a rather stark contrast with the last 6-8 months of the last administration who seemed to be silently watching Rome burn), one of the persistent themes is the irresponsibility and threat of abuse from the least powerful players in the game: folks facing foreclosure, elderly people buying medication, union members with healthcare coverage.

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The following is a guest post from Tamar Abrams, a communications strategist working with nonprofits, individuals and foundations. Until August 2008, Ms. Abrams was Vice President of Communications at Population Action International and has also been on staff at NARAL and Planned Parenthood Federation of America.

Below, Ms. Abrams shares her thoughts on children affected by homelessness.

One in 50 children in the U.S. is homeless each year, according to America’s Youngest Outcasts, a new report from the National Center on Family Homelessness released on March 10. An astonishing 1.5 million homeless children! Chances are you’ve met a child who has spent time in the uncertain and violent world of people without homes. You may not have known – often they look very much like our own children. But the things our kids worry about – grades, video games, iphone or blackberry? – are very different from children who worry about their peers discovering their living situations.

According to the report, children experiencing homelessness have twice the rate of moderate to severe health conditions compared to middle class children, and twice the emotional problems. They struggle in school, with an average 16% lower proficiency in math and reading, and an estimated graduation rate below 25%. Many are cared for by single moms, and a large number are under the age of five.

The report ranks each of the 50 states according to how many children are homeless, their well-being, how many others are at risk of homelessness, and what policies are in place to support them. The states that ranked as the best were Connecticut, New Hampshire, Hawaii, Rhode Island, North Dakota, Minnesota, Wisconsin and Massachusetts. At the bottom of the rankings were: Texas, Georgia, Arkansas, New Mexico, Louisiana, Nevada, North Carolina and Florida.

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Anthropologist Christine Gray, Ph.D., became a healthcare activist when her daughter was diagnosed with a sarcoma in 2003. Fourth in a five-part series on gender disparities in health care.

As excellent as Oprah and her guests may be, how ludicrous is it that American society has normalized the “Oprah-ization” of women’s health care, wherein the medical advice given invariably attaches to a consumer tie-in of some sort, like a book promotion? That would be akin to the population at large following advice on cholesterol reduction presented on a television show sponsored by Lipitor. As Simone de Beauvoir might say (rolling over in her grave), this phenomenon truly relegates women to the position of Other. For men to get a grip on basic healthcare issues, see your G.P. For women, try Oprah!?

Unfortunately, there are limitations to media magic – like reality. Besides recommending that women give up “extras” in their lives — dinners out, new shoes and costly children’s birthday parties — in order to pay out-of-pocket for hormonal relief, Robin McGraw recommends that women physician shop until they not only find practitioners who take menopausal symptoms seriously, but are willing to go off track to address them. Meaning re-invent medicine. If Oprah and Robin have trouble being heard by their physicians, and mainstream medicine regards symptomatic packages of stress-fatigue-depression-sleeplessness-hot sweats as bothersome (not easily dealt with) or inconsequential, and cutting edge treatments are regarded as experimental frou frah (not manufactured by Big Pharma), what of the rest of us? Particularly in hard economic times, the majority of the population cannot be constantly innovating in order to find solutions to routine health care problems.

There is yet another subtle and disturbing issue at hand, however. Can the (mostly male) romance with health information technology (HIT) , the rise of e-communities, participatory medicine, sophisticated medical websites and the like, obscure the possibility that there may be a near total disconnect between women’s ability to access reliable medical information and their ability to actually obtain that care? As per my own experience, being on the right side of the Digital Divide may guarantee naught but humiliation, delay, retaliation and denial of service.* The Surcharge for Disruption.

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Anthropologist Christine Gray, Ph.D., became a healthcare activist when her daughter was diagnosed with a sarcoma in 2003. Third in a five-part series on gender disparities in health care.

How does one identify gender disparities in medicine? Bird by bird (one by one), as author Anne Lamott might suggest. Unfortunately, these particular birds add up to the proverbial “ton of feathers” that knocks women out of academia, including medical academia — if not the flock of alleged Canadian geese that knocked US Airways flight 1549 into the Hudson River.

In California, for instance, it is legal for health insurance companies to impose gender ratings (meaning higher rates for women) on individual health care policies. This results in women paying as much as 39% more for coverage than men.

Historically, birth control, regarded by conservatives as one of the few legitimate “women’s issues,” has likewise been treated by insurance companies as “extra.” (Viagra, apparently not.) The first provision in Obama’s stimulus package to be targeted by outraged conservatives concerned contraception for low income women, an “add on” promptly dropped by Democrats.

Using Oprah, arguably the supreme female anecdotal source in the land, if not Robin McGraw as reference, one might reasonably assume that issues of aging for women are routinely “whited out” of diagnostic check lists, a nice cost-saving device for insurance companies.

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