San Diego Education Report
Telemedicine transformation: Creating 'Super Docs'
May 07, 2013
Eric Wicklund

The nation's top integrated healthcare networks are using telemedicine to
"build" a better physician, according to panelists speaking at a May 6 briefing
hosted by Healthcare IT News, sister publication of PhysBizTech. The session
was part of the American Telemedicine Association's annual meeting in Austin,

"I've just taken a primary care doctor and turned him into a Super Doc," offered
Jeffrey Benabio, MD, a dermatologist and director of healthcare transformation
for Kaiser Permanente in San Diego. "And I can do that with any primary care

Absent the cape, the skin-tight outfit and the phone booth, today's physician
has the potential to reach new heights through telemedicine. That's because he
or she is becoming a part of an integrated healthcare network that can provide
instant access to new tools, resources and experts, thus improving clinical
outcomes and reducing wasteful care.

That was the gist of the panel discussion, titled "Connected Care at a
Crossroads: How Integrated Healthcare Systems are Using Telemedicine to
Coordinate Care." Moderated by Andrew Watson, MD, medical director for the
Center for Connected Medicine at UPMC in Pittsburgh, the panel featured
Benabio; Donald J. Kosiak, Jr., MD, executive medical director of Avera eCARE
for the Sioux Falls, S.D.-based Avera Medical Group; and Wesley Valdes, DO,
medical director of telehealth and virtual medicine for Intermountain Healthcare
in Salt Lake City.

The panelists each explained how their networks are using or planning on using
telemedicine to improve the experience for both patient and physician. They
were challenged by Watson to prove why such tools and projects are beneficial,
in terms of both clinical outcomes and sustainability.

Their response? Telemedicine brings together disparate resources no matter
where they're located and pushes healthcare to the consumer, no matter where
he or she is located. "[We go] where the patient is," said Benabio.

"It's about care coordination, cost avoidance, putting the pieces together and
going to the cloud," added Watson.

For Kosiak, whose network comprises "several tertiary care centers followed by
miles and miles and miles of nothingness," telemedicine enables him to bridge
the geographical gaps involved in delivering healthcare – in particular,
emergency and intensive care services – across the sparsely populated
northern Midwest states. Creating that network allows him to bring a specialist
into the conversation when an accident victim in a distant farm community
needs immediate help.

At Intermountain, meanwhile, Valdes said the system is making a $25 million
investment to create a telemedicine infrastructure in the hospitals, before even
thinking of moving out to the remote clinics and care centers. The program's
goal, he said, is to first make the patient's hospital stay more efficient and cost-
effective, then to push care management out beyond the hospital's walls.

"It's really all about the patient and what's best for them," he said.

For Benabio, the goal of telemedicine is to give the primary care physician
access to whatever he or she needs to become a better, more efficient
healthcare provider.

"It's rewarding because it gives us some sense of autonomy and meaning to
what we do," he said.

All four panelists pointed out that telemedicine has the potential to effect large-
scale changes in healthcare delivery, and physicians have to be able to adapt
to those changes. Since integrated healthcare networks now include health
plans, they're taking on some of that risk -- and they're more mindful of the
outcomes and the ability to manage healthcare in between patients' trips to the
doctor's office or hospital. They're working in patient-centered healthcare, and
learning to see the patient as a partner.

"It's a balancing act with telemedicine," Watson said.

Added Valdes, "If we want to transform healthcare, we have to transform

Kaiser medical records--electronic
Dr. Jenny Devitt discusses
electronic medical records

[Maura Larkins informed
Assistant Area Medical
Director Devitt on Nov. 16,
2011 that Kaiser had
canceled its own quality
regarding missing
digitized X-rays.  Dr. Devitt
ignored the letter.  This
attitude could explain
Kaiser's failure to diagnose
cancer patients who later die
Two views on
electronic medical
“Once you get a diagnosis in
there or a medication or
something that's incorrect,
that's an error, it gets
repeated and repeated and
repeated,” Dr. Benson said.

Electronic Medical
Records 'Not Ready
For Primetime'?
Christin Ayers
7NEWS Reporter
April 29, 2009

DENVER -- Critics say some
Denver area hospitals are
moving too quickly to
implement electronic medical
records (EMRs), failing to
work out some major flaws in
software systems that contain
patients’ sensitive medical

At a number of major
hospitals in the metro area
and at some small clinics,
when you go in for a check-
up, your medical information
goes, not onto a paper chart,
but into a computer.

The Obama administration is
offering $20 billion in
incentives for doctors and
who start using electronic
medical records. But some
critics say Colorado hospitals
have gone digital without
taking care of some kinks in
their systems.

Dr. Louise Benson, an
internist, has used electronic
medical records. She said
there are documented cases
of EMR systems
miscalculating medication
dosages and drug
interactions, which could
endanger patients.

“If you are relying on a
program to tell you what the
interactions are and you
prescribe something and it
pops up OK and it turns out
not to be OK because there's
an error in the program, that
could be deadly for the
patient,” said Benson.

An article in the March
Journal of the American
Medical Association points
out that companies that sell
electronic medical records
take no responsibility if a
software malfunction causes
a medical error.

“Vendors are not responsible
for errors their systems
introduce in patient treatment
because physicians, nurses,
pharmacists and health care
technicians should be able to
identify--and correct--any
errors generated by software
faults,” the article says.

Doctors at Children’s
Hospital, University of
Colorado Hospitals, Colorado
Kaiser Permanente and
Denver Health all use
electronic medical records
and have touted the benefits
of the systems.

In December, the four
hospitals launched a system
that allows them to digitally
share the medical information
of emergency room patients,
with their permission.

“Colorado has been I think on
the forefront in terms of trying
to share information among
various institutions that have
the capability of an electronic
medical record,” said Dr.
David Kaplan, chief medical
information officer at Children’
s Hospital. “Having electronic
medical record has really
been a major breakthrough at
our institution. For the first
time ever, we have everything
right in front of us.”

Dr. Ann Martin, director of the
Longmont-based Colorado
Women’s Care and Medical
Spa, also uses electronic
medical records. She said
they cut down on errors.

“I think the benefits are
everyone can read the
notes,” said Martin. “That's
number one. Some doctors
are notorious for not being
able to read their writing.”

But Benson worries Colorado
hospitals and small
practitioners are moving too
fast with the technology. Dr.
Benson said another major
concern she has about
EMRs, is that once erroneous
information is entered into a
patient’s record, it is nearly
impossible to get erase.

“Once you get a diagnosis in
there or a medication or
something that's incorrect,
that's an error, it gets
repeated and repeated and
repeated,” Dr. Benson said.

Benson said she believes
electronic medical records
can improve patient care, but
that major improvements
need to happen before they
go mainstream.

“They are not ready for
primetime from many
standpoints,” she said.
They can save lives or
they can be deadly
They can be deadly
San Diego Education Report
San Diego
Education Report
San Diego Education Report
San Diego
Education Report
Blog: Kaiser Permanente
Kaiser Permanente links
Filing a complaint
Thank Heaven for Insurance
Companies blog
See also Kaiser concealing records
Dr. Jenny Devitt
Medical Records
Electronic records

Suit Over Medical Records Subpoena Goof Revived
Courthouse News Service
July 05, 2016                    

  PASADENA, Calif. (CN) — The Ninth Circuit revived claims on Tuesday by a
woman whose medical records were used against her because Los Angeles County
prosecutors told the Kaiser hospital she was dead.
  Detrice Garmon had wanted to give alibi witness testimony in her son's murder
trial but ran into a complication with state-court procedure because she was
scheduled to have a brain tumor removed.
  Though Garmon authorized Kaiser Permanente to provide the prosecution with
medical records related to her tumor, the lead prosecutor instead subpoenaed all of
Garmon's medical records from Kaiser.
  In a declaration support the subpoena application, Los Angeles County Deputy
District Attorney Michele Hanisee misrepresented that Garmon was the murder
victim in her son's trial.
  Relying on her full medical records, the state undermined Garmon's witness
testimony. Her son was convicted of murder.
  Garmon soon filed a federal complaint pro se against Kaiser, the county, Hanisee
and Steve Cooley, who had been the district attorney of Los Angeles at the time.
  Though the court dismissed Garmon's entire complaint, she scored a reversal
today from the Ninth Circuit.
  The three-judge appellate panel said Hanisee does have absolute immunity for
issuing the subpoena but that her accompanying declaration is another matter.
  Writing for the panel by designation from Oakland, Senior U.S. District Judge
Claudia Wilken cited precedent from a 1997 decision by the U.S. Supreme Court,
Kalina v. Fletcher.
  "Like the prosecutor in Kalina, Hanisee's declaration states particular facts under
penalty of perjury, making her more akin to a witness than a prosecutor in this
function," Wilken wrote. "Thus, following Kalina, Hanisee is not entitled to absolute
immunity for her declaration in support of the subpoena."
  After finding that the same is true of former DA Cooley, the court said Garmon
also deserves a chance to cure the errors in her claims against the county with an
amended complaint.
  Wilken noted that pro se litigants are not held to the same stringent standards as
those represented by counsel, and that Garmon's complaint could be construed to
include a theory of municipal liability against LA County.
  The ruling concludes with Wilken also reviving Garmon's state-law claims against
the LA defendants and against the medical group.
  "Kaiser does not dispute that supplemental jurisdiction is appropriate if any
federal claim against county defendants survives," Wilken wrote. "Because we
reverse the dismissal of certain federal claims against county defendants, we
reverse the district court's dismissal of claims against Kaiser."
  Garmon had filed her suit pro se but was represented in the appeal by Brian
Morris with Duane Morris in San Diego.
  LA had been represented by principal deputy county counsel Millicent Rolon.
  Kaiser was represented by David Pruett, an attorney with Carroll, Kelly, Trotter,
Franzen, McKenna & Peabody, of Long Beach.
  None of the attorneys returned emails Friday seeking comment.

Lynette Seid, head of San Diego Kaiser Medical Records, creates hoax to
prevent patient from obtaining medical records
Decision Ninth Circuit
Lynette Seid subterfuge
News, information and ideas about our
education system, courts and health care
by Maura Larkins