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Tag: health

  • Understanding the Debate on AI in Electronic Health Records

    Understanding the Debate on AI in Electronic Health Records

    Background

    Artificial Intelligence (AI) refers to the use of computer algorithms to process data and make decisions, ultimately streamlining administrative processes. In healthcare, AI is being increasingly integrated with Electronic Health Records (EHRs)—digital systems that store and manage patient health information, such as medical history and diagnoses. By 2021, almost 80% of office-based physicians and virtually all non-federal acute care hospitals had implemented an EHR system. As part of this widespread adoption, various AI applications in EHRs are beginning to emerge. So far, the main functions of AI in EHRs include managing datasets of patient health information, identifying patterns in health data, and using these patterns to predict health outcomes and recommend pathways for treatment. 

    Arguments in Favor of AI in EHRs

    The use of AI in EHRs presents opportunities to improve healthcare by increasing efficiency as well as supplying administrative support. Supporters of AI integration argue that it can significantly improve diagnostic accuracy. AI-integrated EHR systems can analyze vast amounts of patient data, flagging potential issues that might otherwise be overlooked by human clinicians. Machine learning algorithms can identify patterns across multiple cases and recommend diagnoses or treatments based on evidence from similar cases. Proponents contend that by reducing human error and providing real-time insights, AI could support doctors in making more accurate and quick decisions, leading to better patient outcomes.

    Proponents of AI in EHRs also argue that AI has the potential to significantly reduce healthcare inequities by providing better access and more personalized care for underserved populations. AI-powered tools can identify at-risk patients early by analyzing complex data, including demographic and behavioral factors, and help prioritize interventions for those who need it most. Additionally, AI can bridge communication gaps for patients facing language barriers or low health literacy, ensuring they receive clear and relevant information about their health. Supporters also suggest that AI’s ability to reduce human biases in clinical decision-making, such as disparities in pain assessment or treatment recommendations, could lead to fairer, more equitable healthcare outcomes for all.

    From the workforce perspective, supporters argue that AI integration in EHRs has the ability to significantly reduce physician burnout by streamlining the documentation process. With the increasing time spent on EHR tasks, AI-driven tools like voice-to-text transcription, automated note generation, and data entry can cut down the time physicians devote to administrative duties. For instance, one 2023 study reported that AI integration in health records led to a 72% reduction in documentation time, equating to approximately 3.3 hours saved per week per clinician. This allows doctors to spend more time on direct patient care and less on paperwork, which supporters contend will improve job satisfaction and reduce stress.

    Arguments Against AI in EHRs

    While some argue that AI in EHRs will lead to more accurate and equitable healthcare, others raise concerns regarding data bias, privacy, and transparency. Critics of AI integration argue that modern legal frameworks lack adequate safeguards for individuals’ health data, leaving sensitive information vulnerable to breaches. For example, data collected by AI tools may be hacked or gathered without consent for marketing purposes. Additionally, certain genetics testing companies that operate without sufficient legal oversight may sell customer data to pharmaceutical and biotechnology companies.

    Moreover, some critics share concerns about whether AI integration in EHRs aligns with standards for informed consent. Informed consent is a key ethical principle that ensures patients are fully informed and in control of decisions regarding their healthcare. It includes elements such as the patient’s ability to understand and make decisions about their diagnoses, treatment options, and any risks involved. Ethical responsibility dictates that consent should be specific, voluntary, and clear. The rise of AI in healthcare applications has increased concerns about whether patients are fully aware of how their data is used, the risks of procedures, and potential errors in AI-driven treatments. Autonomy principles state that patients have the right to be informed about their treatment process, the privacy of their data, and the potential risks of AI-related procedures, such as errors in programming. Critics say that patients must be more informed about how AI is integrated into health records systems in order for them to truly provide informed consent. 

    Another significant ethical concern in the use of AI and machine learning (ML) in healthcare is algorithmic bias, which can manifest in racial, gender, and socioeconomic disparities due to flaws in algorithm design. Such biases may lead to misdiagnosis or delayed treatments for underrepresented groups and exacerbate inequities in access to care. To address this, advocates push for the prioritization of diverse training data that reflects demographic factors. They hold that regular evaluations are necessary to ensure that AI models consistently remain fair over time, upholding the principles of justice and equity. 

    Future Outlook

    Building on the potential of AI in healthcare, H.R. 238, introduced on January 7, 2025, proposes that AI systems be authorized to prescribe medications if they are approved by the Food and Drug Administration (FDA) and if the state where they operate permits their use for prescribing. This bill represents a significant step in integrating AI into clinical practices, going beyond data management to reshape how medications are prescribed and managed. The arguments for and against H.R. 238 mirror the debate around AI integration in EHRs; while proponents of the bill argue that AI could enhance patient safety, reduce errors, and alleviate clinician burnout, critics highlight concerns regarding the loss of human judgment, data privacy, and the potential for AI to reinforce biases in healthcare. As AI continues to play a central role in healthcare, bills like H.R. 238 spark important discussions about AI’s ethical, practical, and legal implications in clinical decision-making.

    Summary

    In conclusion, the integration of AI into EHRs has forced medical stakeholders to balance a need for improvements in accuracy and efficiency with a concern for medical ethics and patient privacy. On one hand, AI can support more accurate diagnoses, enhance patient care, and help reduce the burnout faced by healthcare providers. Additionally, AI may contribute to reducing healthcare inequities by providing better access and more personalized care, especially for underserved populations. However, the implementation of AI also raises concerns regarding data privacy, algorithmic bias, and informed consent, suggesting a need for more careful implementation and oversight. As AI’s presence in healthcare settings continues to expand, addressing these concerns will be key to ensuring it benefits patients and healthcare providers alike.

  • Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Introduction

    The United States faces a maternal mortality crisis, with maternal death rates significantly higher than other high-income nations. According to the CDC, maternal mortality disproportionately affects Black, Indigenous, and rural communities, with Black women experiencing maternal deaths at 2.6 times the rate of White women. The factors contributing to these disparities are complex and include unequal access to quality healthcare, socioeconomic barriers, and more. Despite advancements in healthcare, 80% of maternal deaths are preventable through timely medical intervention and comprehensive data collection. 

    What are MMRCs?

    State-based Maternal Mortality Review Committees (MMRCs) have been shown to play a pivotal role in analyzing maternal deaths to recommend evidence-based interventions. MMRCs are multidisciplinary teams that examine maternal deaths occurring during pregnancy or within one year postpartum. They utilize comprehensive data sources, including medical records, autopsy reports, and social service information. MMRCs assess preventability and contributing factors, allowing them to identify patterns and propose targeted policy solutions. Their review process centers on critical questions related to medical factors, social determinants, delays in care, and provider bias. By systematically addressing these factors, MMRCs generate insights that inform strategies to reduce preventable maternal deaths, which comprise 20% to 50% of all maternal deaths in the U.S.

    However, MMRCs face inconsistent funding and regulatory barriers, limiting their ability to track and analyze maternal deaths across states. Disparities in data collection methods and access to comprehensive patient records further hinder efforts to address maternal health inequities. Some states lack the authority to access certain medical records, while others experience delays in data sharing, reducing the timeliness and effectiveness of recommendations. Without consistent federal funding, many MMRCs struggle to maintain operations, particularly in rural and underserved areas, where maternal health disparities are often most pronounced. 

    Introduction to the Preventing Maternal Deaths Reauthorization Act

    The Preventing Maternal Deaths Reauthorization Act of 2023 (PMDR) was introduced to the House Committee on Energy and Commerce by Congresswoman Robin Kelly (D-IL) on May 18, 2023. The bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee in Fall 2023 and passed the House with bipartisan support in March 2024. However, the bill failed to pass the Senate before the end of the legislative calendar, rendering the bill “dead”. The reauthorization built upon the original Preventing Maternal Deaths Act of 2018, which helped establish and fund state-based Maternal Mortality Review Committees (MMRCs) to investigate maternal deaths and identify preventable causes. It sought to extend funding for MMRCs, enhance data collection, and address racial disparities in maternal health outcomes through the following provisions:

    1. Extending funding for state-level MMRCs to continue investigating maternal deaths
    2. Authorizing $58 million annually for the CDC to support state-level efforts
    3. Enhancing data collection on factors related to maternal health outcomes, particularly for minority populations
    4. Strengthening community-based interventions to reduce racial and ethnic disparities 
    5. Enhancing coordination among agencies to implement evidence-based solutions
    6. Expanding research on social determinants of maternal health 

    Arguments in Support

    Proponents of the PMDR Act of 2023 argue that the bill provides critical support for tried and true interventions to prevent maternal deaths. They emphasize that scientific literature identifies state-based MMRCs as the “gold standard” for preventing maternal deaths due to their multidisciplinary analysis. However, inconsistent funding threatens the effectiveness of MMRCs, particularly in states with high maternal mortality rates. In a letter to Congress, 125 public health and social services associations urged legislators to treat the PMDR as a top-priority bill, stressing the nation’s consistently high maternal mortality rate. Several national associations, including the American Medical Association, argue that continued federal funding is crucial to preventing maternal deaths. They highlight that past funding gaps resulted in reduced MMRC operations, hospital closures, and increased barriers to care. Supporters contend that the only way to ensure MMRCs can continue their vital work without funding disruptions is to pass the PMDR.

    Proponents of the PMDR Act also highlight its potential to promote health equity. Beyond identifying risk factors, MMRCs are critical in addressing racial, socioeconomic, and geographic disparities in maternal health by filling critical knowledge gaps on the drivers of maternal mortality in underserved populations. The PMDR Act directly supports these efforts by requiring MMRCs to report on disparities in maternal care and propose solutions. Federal support through this bill enables MMRCs to strengthen provider training, expand access to prenatal care, and address structural barriers contributing to maternal deaths. Without reauthorization, proponents argue, efforts to close maternal health gaps would be fragmented, leaving vulnerable populations without necessary protections.

    Arguments in Opposition

    The most prominent critique of the PMDR Act is that it focuses too heavily on MMRCs. Critics voiced concerns about MMRCs’ inconsistency, lack of accountability, and failure to acknowledge all social determinants of health. 

    Opponents highlight that legal and logistical challenges, such as data collection issues and lack of legal protections for participants, can create disparities in MMRC operations. Rural populations, who face higher maternal mortality rates and limited access to care, are often overlooked in MMRCs, further exacerbating disparities. Additionally, bureaucratic barriers and state laws limiting community involvement in MMRCs reduce their effectiveness in addressing maternal health challenges. 

    Others argue that MMRCs lack accountability, particularly regarding inclusivity and equitable decision-making. Advocates contend that MMRCs often exclude community representatives or organizations that challenge the status quo, prioritizing clinical expertise over individuals with lived experience. This exclusion can foster distrust, as community members may feel their knowledge and perspective are undervalued. The lack of compensation for community members to attend all-day MMRC meetings – unlike salaried clinicians – adds another barrier, further entrenching inequalities. Laws that impose burdensome requirements on MMRCs further complicate the process and reduce diversity in ideas. Opponents of the PMDR contend that these factors contribute to a lack of accountability from MMRCs, preventing them from fully creating lasting and inclusive solutions. 

    Finally, critics assert that MMRCs often fail to adequately address the underlying social determinants of health that contribute to maternal mortality. While MMRCs focus on clinical factors, such as healthcare quality and implicit bias, they can lack the frameworks to assess other social determinants like housing instability, food insecurity, or socioeconomic status. Often, these factors are deeply rooted in the broader healthcare system and community environments. Critics argue that the absence of these social factors in MMRC reviews limits the committees’ ability to develop holistic prevention solutions. Reports suggest MMRCs could benefit from incorporating a health equity framework and utilizing socio-spatial measures to address the full spectrum of challenges mothers face. Without this consideration, critics argue that MMRCs fall short of offering effective solutions to reduce maternal deaths and disparities. 

    Due to these critiques of MMRCs, critics of the PMDR argue that the bill should allocate more funding toward alternate interventions 

    Conclusion 

    The Preventing Maternal Deaths Reauthorization Act of 2023 represented an effort to extend investment in evidence-based maternal health interventions. While it received strong bipartisan support in the House, it died before a vote in the Senate, leaving MMRC funding uncertain in the years to come. While the bill was applauded for its potential to expand access to maternal care and fill critical knowledge gaps on maternal mortality factors, critics argued it placed too much emphasis on an intervention that lacked consistency and accountability to marginalized communities. 

    Future Outlook

    The Trump administration has implemented significant changes to the National Institutes of Health (NIH), including halting medical research funding and restructuring the agency, which has led to delays and uncertainties in grant approvals. These actions have raised concerns about the future of critical medical research, including studies on maternal health. Given these developments, the future of the PMDR may depend on an evolving public health funding environment. Advocacy groups and policymakers will need to collaborate to ensure that maternal health research and interventions receive the necessary support, despite the current challenges in the federal funding landscape.

  • Understanding the Accountability for Overprescription Debate

    Understanding the Accountability for Overprescription Debate

    Background: The Opioid Epidemic

    Over the past two decades, the opioid epidemic has emerged as a key public health issue in the United States. The first wave of the epidemic was characterized by an increase in opioid prescriptions in the late 1990s paired with marketing from pharmaceutical companies that ensured that opioids were safe for pain management. In the early 2010s, a second wave arose when individuals who had become dependent on opioids sought out heroin as a cheaper and more accessible alternative for pain management. The third wave, starting in the mid-2010s, saw a rise of synthetic opioids such as fentanyl in illegal drug markets, leading to unprecedented levels of overdoses. 

    Prescription opioids are chemicals, both natural and synthetic, that are prescribed for pain management and include commonly-prescribed drugs such as Hydrocodone (Vicodin),  Oxycodone (Oxycontin, Percocet), and Morphine (Kadian). While prescription drugs are used to treat acute to chronic pain related to surgery, injury, or illness, prescription can come with risks. Side effects of commonly-prescribed opioids include increased sensitivity to pain, increased drug tolerance, and withdrawal post-medication. These side effects can lead the way to opioid misuse and addiction. In 2023, 125 million opioid prescriptions were filled in America, and 8.6 million Americans misused prescription opioids.

    Calls for Accountability

    In recent years, blame for the opioid epidemic has shifted towards pharmaceutical companies that produce the drugs and initially advertised their safety. Specifically, many consumers seek to hold pharmaceutical companies legally accountable using the argument that their deceptive marketing tactics have created a public health crisis and therefore constitute a public nuisance. Between 2014 and 2021, more than 3,000 lawsuits were raised against pharmaceutical corporations based on the public nuisance argument. However, 2021 decisions from California and Oklahoma State Supreme Courts held that false advertising was not enough to constitute a public nuisance, weakening the prospects of accountability arguments in other pending cases. 

    Most recently, the U.S. Supreme Court struck down a bankruptcy plan for Purdue Pharma – a major pharmaceutical company – that would have facilitated an $8 billion settlement to the individuals, states, and local governments that had sued the company over opioid-related deaths. While some praised the Court for its refusal to grant Purdue Pharma the bankruptcy relief it desired, others say the Court failed to hold the company accountable by jeopardizing the $8 billion settlement to victims. Today, avenues for holding major pharmaceutical corporations – collectively referred to as Big Pharma –  accountable are highly debated. 

    The Case for Holding Big Pharma Legally Accountable

    Supporters of holding pharmaceutical companies legally accountable for the opioid epidemic cite the companies’ use of deceptive marketing techniques to sell opioids. For example, Purdue Pharma’s Evolve 2 Excellence initiative aimed to increase the sale of OxyContin by instructing their marketing team to promote higher dosages and target high volume opioid prescribers. In 2003, Purdue Pharma launched a misleading marketing campaign about the effectiveness of their prescription drugs despite a lack of proven efficacy in treating pain. In 2014, the city of Chicago sued Janssen Pharmaceuticals, Cephalon, Purdue Pharma, Endo Health Solutions, and Actavis for “knowingly and aggressively marketing [opioids] as rarely addictive” and contributing to several Chicagoan overdose deaths. 

    Proponents of legal accountability for Big Pharma believe that successful lawsuits against major pharmaceutical companies could set important precedents and ensure that other corporations are held accountable for their public health impacts on the US population. When polled, 57% of Americans believed that pharmaceutical companies should be held legally and financially accountable for the worsening opioid crisis. This belief existed across party and ideological lines. An even larger segment of the U.S. population supports compelling Big Pharma to remedy their contributions to the epidemic in other ways, with 73% stating that they want drug companies to fund opioid addiction treatment and 72% arguing that they should distribute naloxone kits for free. 

    Arguments Against Legal Accountability for Big Pharma

    Critics of legal accountability for pharmaceutical corporations argue that lawsuits are temporary solutions that will not deter pharmaceutical companies from producing and marketing harmful drugs in the long term. They hold that given the massive annual profits of the top five pharmaceutical companies, civil suits act as no more than a slap on the. Critics also emphasize the increasing difficulty of using the public nuisance argument against Big Pharma due to the complexities of state and federal oversight.

    Additionally, some opponents of legal accountability for Big Pharma argue that highly-publicized lawsuits only provide a false sense of closure and ignore other factors that underlie the opioid crisis. Critics believe there are multiple causes of the opioid epidemic such as housing and food insecurity, and thus argue that the social determinants of health framework must be adopted in order to best tackle the crisis. Mimi Walters, former United States Representative, discussed how prioritizing settlements with pharmaceutical companies is illogical if people are not simultaneously addressing unfair federal housing programs that create barriers to housing for those who have substance use disorders. Citing lack of economic opportunity, limited drug treatment, and need for pain management as causes of opioid overuse, some believe taking a holistic approach is the only way to manage the opioid crisis from the grassroots. They contend that legal settlements are simply a bandaid solution.

    Moreover, some argue that overprescribing doctors hold just as much responsibility for the opioid epidemic as the corporations that market the drugs. Patient satisfaction and expectations for pain-free experiences have become central to the healthcare industry, leading some doctors to prescribe strong opioids for slight injury rather than saving them for persistent, chronic pain. Critics believe that this push for patient satisfaction, along with a focus on the monetary value of patients, creates a cycle in which physicians prescribe to make money. Opponents also cite the Food and Drug Administration’s (FDA) lack of regulation as a contributing factor. In 2017, the Presidential Commission on Combating Drug Addiction and the Opioid Crisis found that the epidemic was partially caused by gaps in FDA oversight. In 2002, 8 out of 10 members of an FDA advisory committee on opioid prescription had ties to Big Pharma. The committee advised the FDA against regulating overprescription, causing many to argue that accountability efforts should include government agencies and not just corporations.

    Conclusion

    Efforts to hold pharmaceutical companies legally accountable have gained traction in recent years. In 2023, Michigan became the last state in the nation to repeal its legal immunity for pharmaceutical companies. In October 2024, the U.S. Department of Justice brought charges against several pharmaceutical companies and brokers for their role in the unlawful distribution of nearly 70 million opioid pills. While many applaud these efforts, some see them as short-term solutions and argue they must be part of a larger comprehensive approach to address the far-reaching consequences of the opioid epidemic in the years to come.

  • The “Let Pregnancy Centers Serve Act” of 2024: Key Insights and Implications

    The “Let Pregnancy Centers Serve Act” of 2024: Key Insights and Implications

    What are Crisis Pregnancy Centers?

    Crisis pregnancy centers (CPCs) are nonprofit, community-based organizations that aim to ensure pregnant people carry their pregnancy to term. CPCs provide services, including pregnancy tests, ultrasounds, baby formula, and diapers to achieve their mission. While they have operated in the U.S. for decades, CPCs have become more prominent in the public eye in light of the Supreme Court’s Dobbs v. Jackson decision that overturned the national right to abortion. Contention has emerged concerning whether CPCs should continue to receive federal funding and qualify as eligible healthcare centers for patients using federal healthcare assistance programs. 

    Introduction to the Let Pregnancy Centers Serve Act of 2024

    The Let Pregnancy Centers Serve Act of 2024 was introduced to the Senate Committee on Finance by Senator Cindy Hyde-Smith [R-MS] on January 18, 2024, and is currently in the introduction stage. The Act contains two central provisions:

    1. Maintaining TANF Eligibility: Temporary Assistance for Needy Families, or TANF, is a government program that provides financial assistance to pregnant people and families for the purpose of accessing food, housing, healthcare, and other necessities. States have autonomy in implementing TANF, including determining the type and amount of assistance payments, and the services that can be obtained with TANF funds. The Act would ensure that people who receive TANF can use their benefits to pay for CPC services, and that CPCs can continue to receive TANF-delegated funding from the federal government.
    2. Renewing federal funding: The Act would prevent the federal government from denying CPCs funding via grants, on the basis that doing so merits federal discrimination against grantees. 

    Arguments in Support of the Let Pregnancy Centers Serve Act of 2024

    Enhanced Access to Pregnancy Services

    Proponents of the Act argue that PCPs should be praised for the broad range of goods and services they provide at little to no cost, such as baby clothes and formula. Early pregnancy confirmation is cheaper and more accessible at a CPC than at an abortion clinic, which supporters argue increases accessibility. They cite a study that showed that patients without health insurance were significantly more likely to visit a CPC than not to visit a CPC during their pregnancy. Additionally, proponents believe that the educational programs provided by some centers, such as parenting classes and prenatal care, help equip new and expecting parents with necessary knowledge and skills. In addition, some CPCs offer different types of emotional and psychological support. Advocates of the Act believe that the counseling services provided by some centers can help individuals and families navigate the pregnancy experience and its complexities. 

    Protection from Federal Discrimination

    One of the primary objectives of the Act is to ensure that CPCs continue to receive TANF funding. The bill aims to prevent the Biden administration’s proposed rule that would reduce or cut TANF funding to CPCs. Proponents argue that these centers play a crucial role in providing support to pregnant women, and that losing TANF funding eligibility could significantly impact their ability to offer essential services. Advocates of the bill argue that protection against federal discrimination is crucial for maintaining the viability of CPCs and ensuring they can continue to provide their service without undue interference. Advocates emphasize that CPCs have been allowed to receive federal funding since 1996, and that reversing this practice signals federal discrimination on a national scale. Proponents also argue that states should have the flexibility and power to direct funds to organizations that align with their values and priorities, and that the federal government would infringe upon state’s rights by prohibiting funding to CPCs nationally. 

    Arguments Against the Let Pregnancy Centers Serve Act of 2024

    Misleading Patients 

    Opponents of the Act argue that CPCs provide misleading or incomplete information about reproduction with the goal of preventing patients from seeking abortion, which can impact patients’ ability to make informed decisions about their health. Most crisis pregnancy centers have a religious affiliation and are not medically licensed, and thus fall outside the scope of consumer protection regulations that are designed to protect patients. Opponents argue that CPCs purposefully and unethically market themselves as health clinics, which has led to the development of websites like ExposeFakeClinics.com and The Anti-Abortion Pregnancy Center Database to warn patients about CPCs in their area. 

    Critics also claim that many ethical concerns that arise when the government provides TANF funding to organizations that are unqualified to provide medical advice. In particular, critics argue that CPCs’ main goal is to discourage or delay women from seeking abortion services, and that providing them with TANF funding could lead patients to perceive them as legitimate and objective healthcare providers. Delays in medical care, whether it be prenatal checkups or appointments about different options, can lead to more complex and costly procedures later on, and potentially put pregnant people’s lives at risk. Critics believe that by prioritizing funding for un-licensed pregnancy centers, the government risks misleading pregnant people into seeking services at centers with no medical credentials and thus neglecting their healthcare needs.

    Misuse of Federal Funds

    Additionally, opponents of the Act are concerned that CPCs lack the oversight and accountability required of other TANF-eligible medical facilities, which could increase the risk of mismanaged or ineffectively-used federal funds. While states must spend TANF funding on programs that achieve one of four TANF purposes, some argue that CPCs are deceptive and lack patient-centered care. Critics of the Act believe that TANF dollars could be used in more efficient ways than funding CPCs, such as promoting job preparation and work. They believe that funding CPCs risks diminishing government funds that could be used to fund prenatal care, contraceptive counseling, and more comprehensive maternal health services. Many believe that allowing TANF funds to support CPCs could weaken the overall monetary support network for reproductive health in the nation. 

    Conclusion

    The Let Pregnancy Centers Serve Act of 2024 aims to protect crisis pregnancy centers by allowing states to allocate TANF and other federal grant funds to these centers without federal interference. Supporters argue that CPCs offer vital services that deserve protection and uphold states’ rights to manage their grant distributions. Conversely, opponents express ethical concerns about funding centers that lack medical qualifications, licensure, and oversight. Critics warn that the Act could misallocate federal funds, diverting resources from licensed maternal and contraceptive care programs to less regulated centers. The legislation’s outcome will significantly impact pregnant individuals nationwide.