WASHINGTON (APRIL 16, 2021) – On Thursday, April 15 the House Subcommittee on Health, Employment, Labor, and Pensions Subcommittee during a hearing titled Meeting the Moment: Improving Access to Behavioral and Mental Health Care interviewed Dr. Christine Yu Moutier, Chief Medical Officer from the American Foundation for Suicide Prevention(AFSP). Her testimony included the following:
“Research shows that when primary care and health systems embrace mental health and substance use disorders as integral targets of healthcare delivery, many health outcomes improve. There are enormous economic benefits for societies that prioritize mental health and there is a proven return on investment for each dollar spent on mental health promotion and prevention – in many ways, we cannot afford inaction.
During the COVID-19 pandemic, data show 50-70% of the population report elevations in experiences of depression, anxiety, trauma, loss, and increased substance use. Suicidal thoughts are also much more prevalent during this time especially among young people with 25% of young adults reporting suicidal ideation. As the pandemic has progressed, the proportion of respondents with detrimental effects on their mental health continued to rise. There are reasons to be especially concerned about particular populations: minoritized communities, essential and frontline health workers, caregivers, youth, rural residents and LGBTQ people.
Despite the evident need for broad and equitable access to mental health care, many are having trouble accessing care. These challenges have worsened during the pandemic, despite greater access via telehealth services. The Subcommittee is asked to consider efforts that would support enhanced mental health parity enforcement, to ensure that coverage for mental health care is no less restrictive than medical or surgical care. Recent analyses found evidence of lack of parity in behavioral health services compared with medical/surgical in terms of high out of network use and lower reimbursement for behavioral health services – and these disparities are trending in the wrong direction.
There must be much more accountability and oversight of parity to ensure that mental health conditions are not being discriminated against. In closing, I urge the subcommittee to consider legislation and policies to: ensure effective enforcement of mental health parity and broaden access to mental health care generally; support a robust, diverse mental health workforce; integrate mental health and suicide prevention in health systems, workplaces and schools, as critical touchpoints that can establish a culture that is responsive to mental health needs.
The steps we take in the aftermath of the pandemic will set the trajectory for the Nation’s mental health for years to come. Parity must be enforced, and disparities must be addressed to ensure equitable access and care for those in need.”
The American Foundation for Suicide Prevention is dedicated to saving lives and bringing hope to those affected by suicide. AFSP creates a culture that’s smart about mental health through education and community programs, develops suicide prevention through research and advocacy, and provides support for those affected by suicide. Led by CEO Robert Gebbia and headquartered in New York, with an Advocacy office in Washington, DC, AFSP has local chapters in all 50 states with programs and events nationwide. Learn more about AFSP in its latest Annual Report, and join the conversation on suicide prevention by following AFSP on Facebook, Twitter, Instagram, and YouTube.
Contact: Alexis O’Brien, 347-826-3577, email@example.com
Plan now to complete your Annual Health and Medical Record for this summer
To participate in Scouting events, campouts and high-adventure trips, Scouts and Scouters must complete the Annual Health and Medical Record. Now is the time to make sure your and your Scout’s records are up-to-date and complete, especially if your unit has summer activities scheduled.
The Annual Health and Medical Record has three different parts:
- Part A is an informed consent, release agreement and authorization that needs to be signed by every participant (or a parent and/or legal guardian for all youth under 18).
- Part B is a self-reported general information and a health history.
- Part C is your pre-participation physical exam completed by a certified and licensed health care provider.
Parts A and B must be complete for all activities; Part C is required for events lasting longer than 72 hours. Again, this year, all parts must be current through the end of the adventure in order to participate. Review and complete the AHMR fully and carefully; take a look at this instruction page. If you have more questions, refer to this BSA Safety Moment or look at these frequently asked questions. Remember, these completed forms must be secure, so they are not to be digitized, scanned, emailed or stored electronically by unit leaders.
Because the pandemic is not over, it might be a good idea to schedule an appointment soon for the pre-participation exam rather than waiting until summer. When you meet with your medical provider, bring the AHMR form, and it’s advised, especially if you or your Scout will be attending a BSA high-adventure base, to bring the risk advisory associated with that base. That way, your medical provider can better understand any strenuous activities involved. Council-run high-adventure camps might also have required risk advisories to review and complete. Check with the camp you are attending for any additional forms, such as COVID-19-related forms for high-risk individuals, that are necessary this year.
You should also alert Scout adult leaders of plans to address individual risk factors or medication use. When filling out the AHMR, include all medications; you can include a separate sheet if you run out of room.
Cure the common code: OpenMRS aims to improve medical record systems in developing countries – GeekWire
Consider the difficulties many of us face when we need medical procedures, tests or referrals. Now imagine you lived in a developing country where these challenges can be significantly greater.
For instance, getting a critical blood test might mean being given an informal slip of paper you have to take to a lab somewhere on the other side of town. After traveling for two hours, you wait another three hours to have your blood drawn, then are told to come back two days later for the results. When you return, you collect the handwritten results which you have to deliver back to your referring practitioner two hours away. Clearly, there are many points where the lines of communication could break down.
Unfortunately, such challenges have long been the reality in many parts of the world. That’s largely due to the costs and other demands of establishing standardized electronic medical records systems that can be reliably and securely used by practitioners in low-income developing countries.
This was some of the motivation behind OpenMRS, an open-source medical record system that launched in 2004 to improve healthcare delivery in resource-constrained environments. The program is supported by funding from the Gates Foundation through the PATH Digital Square funding program; U.S. Centers for Disease Control; Mozilla Foundation; Pineapple Fund; Rockefeller Foundation; and others.
The project was initially conceived as a way of improving existing records systems for managing critical healthcare initiatives in developing countries. The program has since expanded to become the world’s largest open-source digital health community and is supported by institutes and teams from around the world.
OpenMRS initially launched to support a clinical care and treatment project in Kenya called AMPATH, an Academic Model for the Prevention and Treatment of HIV/AID project.
“It was modeled in a way that made sense for global health specifically, so people in other low resource settings started adopting it,” said Jan Flowers, chair of the board of directors for OpenMRS.
Flowers is also the faculty co-lead and founder with Dr. Nancy Puttkammer of DIGI (Digital Initiatives Group at I-TECH), the global health informatics center at University of Washington. Over the years, Flowers has been involved in national-scale health informatics projects based in Mozambique, Kenya, Cote d’Ivoire, Haiti, Vietnam, and Namibia.
Today, OpenMRS has been installed at more than 6,520 healthcare clinics, serving 12.6 million patients in 40 countries. These numbers are even more impressive when you consider how much difference exists between healthcare systems around the world. Beyond just the matter of the local language itself, medical terminology, lab test results, billing codes and local regulatory requirements can all differ widely, calling for a system that is highly customizable.
OpenMRS achieves this through its modular construction, the use of what are known as standard concept dictionaries and an Open Concept Lab that enables further customization. This allows each site installation to standardize its different concepts and medical terminology in order to meet local needs without having to alter the program’s core code or back-end structure.
In the end, the primary goal is to enable better, more efficient healthcare around the world, a goal that’s been a huge inspiration for the open-source component of the project.
“Around 2010, we suddenly started to see national-scale implementations of OpenMRS,” said Jennifer Antilla, the organization’s director of community who is also based in Seattle.
While the OpenMRS software makes all of this possible, as a matter of principle, the organization doesn’t perform the clinic installations itself. Instead, they generally partner with other organizations, such as DIGI, to support health ministry’s wanting to use OpenMRS.
The managing partner then teams up with developers and implementers in the country where the installation site is located. This allows the software to be customized and contextualized on the ground. That’s essential because each country’s health ministry has different regulations, different governance, different languages, and different data collection elements they want to monitor and measure.
All of that has to be thought through with those who will actually be working with the system. This often means training local developers and IT professionals, raising their skill levels and building the available talent pool that can later be tapped into for other types of projects.
“At OpenMRS, we’re really committed to equality and making sure that people feel equal, that we’re all peers,” said Flowers. “So, part of our mission is to equip these ministries and organizations with the skillsets and systems that they need to own and sustain the systems themselves for the long term.”
Beyond this, the project connects the end users to an open-source community that has grown to approximately 5,000 members with 75-to-100 main developer contributors consistently active in core activities of the software.
The OpenMRS community has even extended to Google’s Summer of Code (GSoC), which has been involved with the project for several years. The people coming through GSoC or those who are just interested in contributing to the community, either as developers or software engineers, are supported by the OpenMRS fellowship program. That program provides mentors to bridge the gap between how far people get with GSoC and the more advanced skill sets that OpenMRS implementers need. This allows them to advance from junior-level to mid-level developers to eventually become the OpenMRS gurus who actually perform implementations in the field.
The success of the program in developing countries has been extensive, benefiting patients, facilities, tech ecosystems and communities. It’s also demonstrated the many advantages electronic records keeping can offer.
For instance, Haiti has used OpenMRS nationally for its HIV program for many years. When the COVID outbreak hit in 2020, they used their records to determine that issues around COVID were actually interrupting many patient’s HIV treatments. This kind of disruption can have a huge impact and without good records management, they wouldn’t have been able to tell whether people had maintained and adhered to their treatments. Better records management made it possible to do case follow-ups to make sure patients didn’t become infectious and contribute to new infections.
Seventeen years ago, no one imagined how much of an impact this software project would have one day. Literally millions of lives have been improved and made healthier because of this single idea and the commitment of a talented community that wants to improve the world by coding for good.
OpenMRS was founded by Paul Biondich and Burke Mamlin of Indiana University’s Regenstrief Institute; Hamish Fraser of Partners in Health; and Chris Seebregts of JEMBI Health Systems in South Africa.
Health Care & Politics: Woke Ideology Harming Medical World | National Review
Four hundred years ago, Italian astronomer Galileo was persecuted for advancing Copernicus’s theory that the earth and other planets rotate around the sun. This heliocentric theory violated the prevailing belief dating back to Aristotle and engrained in Christian theology that the sun and planets rotate around a stationary earth. Galileo was tried for heresy and placed under house arrest for the remainder of his life. Science would eventually vindicate Galileo.
Today’s scientists and physicians face a different orthodoxy that explains all disparate health outcomes as the result of structural or systemic racism. Doubters and those who investigate genetic and scientific alternative explanations face their own latter-day inquisition. Just ask Howard Bauchner, editor in chief of JAMA — the Journal of the American Medical Association — who was recently forced to resign. While the remaining JAMA editors offered fulsome praise in a farewell editorial citing his accomplishments, including a commitment to Diversity, Equity, and Inclusion, make no mistake: He was purged for a thoughtcrime.
Dr. Bauchner’s offense was that he presided over JAMA when it aired a podcast titled “Structural Racism for Doctors — What Is It?” in late February. The podcast featured two white physicians — JAMA deputy editor Ed Livingston and Mitchell Katz, an editor at JAMA Internal Medicine, president and CEO of New York City’s public-hospital system NYC Health + Hospitals, and a member of the National Academy of Sciences. Dr. Katz described structural racism as societal policies or practices that perpetuate racial inequality, as opposed to individuals’ racist beliefs. Dr. Livingston wondered if “structural racism is an unfortunate term to describe a very real problem.” (emphasis added) He worried that people offended by being labeled racist would not address the societal barriers to equal opportunity. JAMA’s tweet promoting the podcast stated, “No physician is racist, so how can there be structural racism in health care? An explanation of the idea by doctors for doctors. . . .”
While Bauchner did not author or approve the podcast or the clumsy, misleading tweet promoting it, he tweeted an apology for the harm caused by them and for his “lapses” and reaffirmed JAMA’s commitment to “call out and discuss the adverse effects of injustice, inequity, and racism in medicine and society.” He withdrew the podcast, replacing it with an apology for its allegedly inaccurate, offensive, and hurtful comments. Bauchner declared that “racism and structural racism exist in the U.S. and in health care.”
Livingston, the podcast host, resigned from JAMA at Bauchner’s request. Two weeks after, Bauchner himself would be placed on administrative leave by the AMA pending an investigation. Now, two months later, he is gone, too.
It isn’t as if Bauchner and the AMA previously ignored racism. The AMA acknowledged its own history of discriminatory practices in 2008 and this past November labeled racism as a public-health threat. JAMA and other associated AMA publications have published a plethora of articles discussing systemic racism in medicine and restorative justice for communities of color. Bauchner’s apology withdrawing the podcast transcript had links to 115 articles in the JAMA family of journals addressing racism and inequities in medicine. A more recent apology from 15 editors in the JAMA family of journals lists more than 650 “articles on race, racism, and racial and ethnic disparities and inequities” in their journals since 2015. An August 20, 2020, editorial in JAMA Network Open — the AMA’s monthly open-access medical journal — titled “Call for Papers on Prevention and the Effects of Systemic Racism in Health” stated there is “an emerging consensus” that systemic racism exists in society and medicine, referenced ten articles discussing racism and health disparities in AMA publications, and was accompanied by another editorial titled “Responsibility of Medical Journals in Addressing Racism in Health Care.”
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Other medical organizations have been similarly confessional. An October 2020 policy statement on racism and health from the American College of Physicians indicts the organization for past discriminatory practices, calls for policies to address discrimination and racism in health care, medical education, law enforcement, and society, and commits the ACP “to being an antiracist organization.” The New England Journal of Medicine has published 70 articles on race and medicine in the past two years.
Official medicine, adopting the jargon of the day, now apparently believes if you are not an “antiracist,” you are a racist. Systemic racism in medicine is an established fact, and no contrary studies, opinions, or evidence will be allowed. Incoming AMA president Dr. Gerald Harmon rebuffed AMA delegates who challenged the association’s new plan to combat racism, claiming, “The existence of racism within medicine and society, both historically and present day, is not up for dispute.” Questioning this orthodoxy may end your career.
In the wake of Bauchner’s departure, the JAMA journals editors have committed to new editorial priorities that promote diversity, equity, and inclusion and advance antiracism. Needless to say, articles deviating from these priorities will not be welcomed.
Indeed, even speculating that there could be a nonracist cause for health disparities leads to condemnation. A September 2020 JAMA paper examined whether higher COVID-19 infection and death rates in blacks might be explained by the overexpression in blacks of a gene that makes a protein that facilitates the entry and spread of the SARS-CoV-2 virus into nasal cells. Overexpression of the gene was already associated with a higher incidence of prostate cancer in black men versus white men. The researchers found higher gene expression in blacks’ nasal cells compared with other races and reported that trials of inhibitors of the protein that might level the playing field for blacks were underway. Yet a founder of the Institute for Antiracism in Medicine labeled the study “biomedical racism.” A May 2020 Health Affairs paper that found higher risk of hospitalization from COVID-19 for African Americans wondered if there could be “unknown or unmeasured genetic or biological factors that increase the severity of this illness for African Americans” but was forced to revise the article and remove this language.
There is well-known evidence of biologic bases for disparate racial outcomes. Black women do worse than white women with breast cancer. Yet when black and white women with the same common, early form of breast cancer were treated with the same treatments, the black women still had higher rates of recurrences and death. Moreover, a particularly aggressive and lethal form of breast cancer called triple-negative disease is known to be more common in black than white women. These facts suggest that genetic factors, rather than structural factors such as poor access to medical care or systemic racism, are more important explanations for black women’s poorer breast-cancer outcomes. Similarly, prostate cancer is more common and perhaps more aggressive in black than in white men. Ignoring these biologic differences and the therapeutic approaches they suggest will harm black patients.
Dr. Bauchner was purged for allowing others to question the wisdom of applying a political construct, systemic racism, to medicine. Science and medicine thrive on independent inquiry that overturns accepted but erroneous ideas. Both will now be constrained by politically correct modes of thought. Hopefully, we will not sacrifice too many legitimate inquiries into racial differences surrounding the susceptibility to and optimal treatments for different diseases before science, once again, triumphs over authorized beliefs.
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