J. James Rohack, MD, is the 164th president of the American Medical Association, but he is the first one to have his own blog.
"It won't be like, 'Today, I woke up and had oatmeal,'" jokes the senior staff cardiologist at Scott & White Clinic in Temple, TX. Rather, since his job entails spending 200 days a year traveling and hearing voices from the House of Medicine expressing concern about how the system does and doesn't work, he decided it is important to share what he hears with those who care.
And this social media venue seemed worth a try. "It's something we [at the AMA] have been talking about for awhile. Of course, each president has a different comfort level with e-mail. What we wanted was something that would allow a different form of communication."
This year, perhaps more than any other, the AMA is at the center of the health reform debate and those voices, their questions, and concerns are important to convey, he says.
His introductory post came out yesterday, accompanied by a "Virtual Town Hall," a Webcast of voices from the physician community attempting to dispel concerns and myths the public and other physicians have about the impact universal coverage, which the AMA supports.
His second post later this week will focus on "reflective comments about how one communicates in multiple ways without being perceived as overbearing...and at what point does that become overkill." He didn't elaborate, but presumably he's referring to some physicians' concerns that the president is pushing a bit too hard.
"Certainly the president has had some continued exposure with his outreach," Rohack says.
Another planned column will deal with an upcoming physician call-in conference with the White House on issues of concern to doctors. Whether President Obama will be there to answer questions in person is unclear, he says.
Rohack's blog joins a rapidly expanding community of blogging doctors who post and tweet on anything medical from drug-drug interactions to electronic medical record feasibility to questionable patient imaging scans to reviews of the latest hand-held apps.
"With Dr. Rohack starting his own blog, the American Medical Association is further expanding their social media reach, which also includes a presence on Facebook and Twitter," says Kevin Pho, MD, who blogs as www.kevinmd.com/blog.
Rohack's blog for the AMA "can only increase their level of engagement in the current health reform conversation," Pho says.
Rohack isn't just hoping to speak to fellow doctors or others who provide healthcare or make policies governing it. He also wants to speak to patients and the general public. "On the Road" is accessible to anyone, he says.
Some weeks, he will have one post, some weeks seven, he says. It depends on how much time he has, and doesn't have, sitting in airplanes "waiting on the tarmac."
Rohack is a bit worried that he may not have time. He already spends full days seeing about 20 patients a day when he is in clinic. Then there is other AMA business and his personal life. But he says it's important enough that he is going to try to find the time.
"It's supposed to be a recognition that as president of the AMA, one has the opportunity to be in meetings ranging from high schools, to colleges, to Congress to the White House, in rural areas and urban areas–the whole breadth of the U.S."
Rohack says that he will do all the writing himself, but yes, he will have an editor. Someone in the AMA communications office who will make sure he doesn't misspeak.
A board-certified cardiologist, Rohack also serves as the director of the Center for Healthcare Policy and as the medical director for system improvement of the nonprofit Scott & White Health Plan.
Most Americans are satisfied with the status quo for their own healthcare and are doubtful that reforming the system will create affordable or better quality medical care, according to a Thomson Reuters study released today.
The study, which tracks consumer attitudes toward healthcare reform, addresses a wide range of issues, including the cost and quality of healthcare, the prospect of higher taxes, and satisfaction with physicians and insurance coverage.
"It's easy to see why there is considerable disagreement about healthcare reform. People are generally satisfied with what they have, skeptical that change will improve the system, and divided on the role the government should play," says Gary Pickens, chief research officer for the Healthcare & Science business of Thomson Reuters and lead author of the study. "And we're seeing wide variance of opinion across demographic profiles, suggesting it will continue to be challenging for legislators to find the middle ground."
The analysis is based on a telephone survey of 3,007 households conducted from July 28 to Aug. 9—a segment of the Thomson Reuters PULSE Healthcare Survey, which examines healthcare behaviors, attitudes and utilization.
The survey found:
Lack of faith that reform will improve cost or quality: A minority of survey respondents (37.9%) believe healthcare reform will improve the cost of care. Even fewer (30.3%) believe it will improve the quality of care.
Ambivalence regarding federal oversight: 44.5% believe the federal government should play an "active" or "very active" role in the oversight of healthcare, while 53.3% say the government should be "somewhat active" or "not at all active."
Most believe Americans should get the best care, but don't: 71% of respondents agree or strongly agree that Americans are "entitled to the best healthcare available." However, fewer than half (46.3%) believe the United States has the best healthcare system. More than one in four said they don't know which country has the best care; 11.3% say it was Canada.
Majority satisfied with status quo: The survey asked respondents to rate their satisfaction with their healthcare providers, costs, and insurance coverage. About 80% said they were satisfied with their doctor, nearly 70% were satisfied with their health insurance coverage, and about 53% were satisfied with the amount they pay out-of-pocket for healthcare.
Willing to bear a tax increase: About 58% said they are willing to bear a tax increase (1% or more) to support healthcare reform.
Demographics matter in healthcare debate: An analysis of the survey results based on respondents' age, gender, income, and education found that only three demographic segments provided majority support for the provision that all Americans be required to have health insurance: Those under 35, those earning less than $50,000 annually, and women. Meanwhile, the senior population, compared with other segments, showed a greater satisfaction with their healthcare providers and costs, and a greater resistance to reform.
Electronic health records systems and other information technology projects have moved to the top of the agenda at many hospitals and other healthcare facilities. However, the track record of such projects is not encouraging. Technology projects are often subject to high failure rates, extensive cost overruns, and wasteful delays. Even projects deemed "successful" often do not fully realize their promise or meet user expectations.
With an unprecedented number of technology projects planned, underway, or anticipated, the challenge for healthcare executives is not only for projects to be delivered on time and on budget, but also that they meet real user needs and remain relevant even during protracted development cycles that could encompass years.
We faced that challenge at Texas Health Resources when we launched an EHR project in 2005. With 14 hospitals, 18,000 employees, and 3,600 physicians who practice on the medical staffs, Texas Health had an enormous paper database that needed to be converted. At the same time, we needed technology, processes and procedures that could be easily and efficiently used by physicians, nurses, admissions, and other staff.
We benefited from a strong internal project management process that kept the implementation on course. We also found that it was equally important to look beyond the technical execution to how the project's objectives were being met. We repeatedly learned that a critical factor in keeping a project not only on track but also on mission was strong leadership in the form of an executive sponsor.
The EHR project, like others now underway, benefits from a senior management official who "owns" the project and is responsible for making sure that it achieves its value and user expectations. An effective executive sponsor is necessary in complex organizations such as ours, with intersecting organizational charts, overlapping responsibilities, and key stakeholders who are not employees and may have conflicting priorities.
An executive sponsor can improve a project's chances for success by providing leadership, direction, and problem-resolution skills. The ideal sponsor alternates between advocate and arbiter, manages upward and downward, and can clearly communicate the value of the initiative to the business side of the organization.
It is important to recognize that executive sponsors are not meant to replace project managers. Sponsors' focus should be on the bigger picture not on day-to-day implementation and decision-making. The sponsor should complement the project manager and provide the resources and senior management attention the project needs to succeed. Sponsors should also serve as a guide to the project manager, ensuring that the product will continue to be relevant to end users even after the "go-live" date.
But appointing a sponsor is not enough in itself: Organizations must select the right person, with the right skills and authority, and empower him or her to make the necessary decisions to maintain project agility and progress. Here are seven attributes we, at Texas Health, learned were important when selecting an executive sponsor.
Choose a sponsor who will drive the project as a clinical and operational initiative, not as an IT engagement. The temptation when selecting an executive to oversee a multifaceted information technology project is to look for someone capable of understanding the technical aspects of the job. Understanding the intricacies of a project is important. But even more crucial is an ability to recognize how the project fits into the organization's business and its core function of providing care for patients. All too often, technology managers lose sight of the bigger picture and go off track, wasting resources, and ending up with products that do not meet real-world needs. A good executive sponsor, focused on the operational and strategic aspects of a project, can help keep management on track.
Appoint the person, not the position. The choice of executive sponsor should be made on the basis of interest, personality, leadership skills, knowledge, and even availability. A more junior person could be valuable if she or he has the energy, the time, and the commitment to be more than a figurehead. At the same time, the sponsor must be of high enough rank that he or she can command the attention of those higher and the respect of those lower in the hierarchy. Ideally, the sponsor should be someone who understands the project, believes in it, and can champion it effectively.
Identify sponsors early. As a large and complex organization, with 13 acute-care hospitals and one long-term care hospital, Texas Health has a sophisticated governance system with a rigorous budgeting process. Major, resource-intensive projects, such as many of those involving information technologies, are often assigned executive sponsors during the budget process. Even smaller projects are routinely assigned sponsors, although not necessarily at the executive level. Having a champion early on in a project's gestation provides important support during budgeting that translates into a greater likelihood of approval and receiving adequate resources.
Begin oversight immediately. In order to ensure that projects are moving in the right direction, an executive sponsor should work closely with project management from the initiation of the work. This includes establishing user expectations, setting milestones, agreeing on reporting procedures, and putting in place a regular meeting schedule to review progress and share information about any evolution in project needs.
Build a deep bench. One way to balance the concerns of competing units within an organization is to appoint one or more associate sponsors--other well-qualified individuals who are connected to the overriding mission driving the project, but may be of lower rank. The associate sponsors can, even in a subordinate role, articulate their organization's interests, and can be leveraged for political reasons. This can provide an appropriate role for technical experts--chief information officers, chief medical information officers, and others. This also builds a deeper bench of talent, preparing individuals to step in should the executive sponsor be preoccupied with other demands or leave the organization.
Make sponsors the eyes and ears of project management. As projects get underway, managers can become ensnared in the daily details of implementation and lose contact with the needs of their internal clients--the end users of the technologies they are putting in place. Sponsors need to work on fact-finding, meeting with physicians, nurses, admissions officers, billing and coding clerks, et al., to make sure that the project continues to be aligned with the expected value. This is especially important in fast-developing fields such as information technology, where the industry's capabilities are constantly increasing and end user needs change frequently. For example, a medical coding and billing system that does not include an ability to adopt the forthcoming ICD-10 standards will be dead on arrival.
Encourage sponsors to take full ownership. In large, complex organizations with multiple stakeholders, it is understandable for senior executives to defer to one another when their interests conflict. While such collegiality is understandable, and even desirable to a point, it also can result in stagnation with progress slowing to a halt as any and all concerns are addressed. Executive sponsors need to take full ownership of their projects, remembering that their loyalty must be to the project's end users, not to any individual department. They should drive their projects forcefully, lest they be pushed aside in favor of those with more aggressive champions.
Healthcare organizations must remember that technology is not an end in and of itself. Instead, it is a tool that helps staff do its work more efficiently, safer, and with higher quality--whether that means doctors and nurses in a clinical setting, admissions and clerical staff in the front office, or administrative and billing staff in the back office. There have been many successes and failures in the implementation of EHRs and those that do demonstrate success are clinically and operationally driven projects--the executive sponsor should be chosen, and act, accordingly.
The senior sponsor will want to leverage industry best practices. Opportunities exist to learn from other institutions, hire and acquire talent that can bring leading practices, and have independent and knowledgeable third parties provide guidance. At Texas Health, we took advantage of all of these and saved ourselves from some missteps that might have occurred without this expertise. For example, we engaged PricewaterhouseCoopers to do periodic quality reviews of our EHR project.
In the end, the executive sponsor should ensure the project meets its value objectives, enables the users, and that the necessary resources, budget, and project governance are available and functioning. Project managers can be responsible for seeing that projects are delivered on time and on budget, but the executive sponsor needs to ensure that, in fact, they meet the organization's business and strategic needs. The sponsor's role, therefore, is cross-cutting, including not only oversight of technology implementation but also of the organizational and process changes that come part and parcel with major system changes.
By taking full ownership of these projects, executive sponsors accept responsibility for keeping the projects on track to generate the expected results for the affected clinical and administrative processes. Such accountability, even if informal, is rare in many organizations today. Because of that, it can be enormously empowering, giving sponsors the internal credibility and influence to successfully deliver results.
Stephen C. Hanson is senior executive and vice president system alignment and performance for Texas Health Resources. He can be reached at 682-236-7900 or 1-877-THRWELL. For more information, visit www.texashealth.org.
This past week, Vanguard Health Systems, which operates 15 hospitals in four states, joined a growing list of healthcare organizations and employers that plan to offer personal health records to patients or employees. Vanguard joined the Dossia Consortium of employers that have pledged to implement PHR software for their employees.
I wrote about whether personal health records would be a temporary fix or here for the long haul in the August 2009 issue of HealthLeaders magazine PHRs: Worth the Effort.
Given the emphasis on personal health records in the "meaningful use" recommendations by the HIT Policy Committee, it seems that PHRs are here to stay, which I, for one, believe is a good thing.
However, not everyone is convinced that PHRs are the right path for healthcare to take. Some physicians are concerned that the "art" of medicine is being replaced by templates and checklists and that electronic health records along with PHRs could suffer from the quality of data that is entered and exchanged. Other executives believe that the patient web portal may be the better solution.
That is the route Group Health Cooperative in Seattle took when it implemented its patient Web portal. Its philosophy is that the medical record should be a shared document between patients and caregivers that provides the same data to both of them, says Ernie Hood, vice president and chief information officer. The patient view of the information does include some additional definitions and health management information, he explains.
The challenge of PHRs is that until a large number of providers are interfacing with PHR products their use will be for the patients only--and a relatively small number of people currently maintain and actively use them, Hood says. Still, he acknowledges that PHRs will play an important role in the continuity of patient information as patients move between providers.
"PHRs are not the magic bullet that will fix healthcare," Hood says. "They look like a supplement to an EHR, and in some cases a patient orientates and supplements it, but in most cases they are being used by people very concerned about their health record and willing to put their own effort into maintaining it."
For healthcare providers that are interested in building PHR applications, there are some key considerations to help ensure their long term success.
Define the primary objective. "Before you hook up with Google Health or Microsoft, you have to ask, 'Why am I doing it and what are the benefits for the organization,'" says Hood. The approach will be different if you are doing it to save money versus improving the patient experience. "Don't just jump because other people are doing it," he advises, adding that he wouldn't undervalue connecting the organization's focus on the patient to consumerism, either. “That is a factor that has been missing in healthcare."
Determine the organization's readiness. The healthcare industry has been paternalistic about health records, so organizations need to have senior leaders who want to release records and an institution that is open to this, says Aurelia G. Boyer, senior vice president and CIO at NewYork-Presbyterian Hospital. "We feel like patients own the data and we are the custodian of the data," she says.
Ownership is sticky wicket, says Hood. "If you look at from the patient standpoint, it is data about them," he says. But full ownership means that you have the right to destroy information. From a physician perspective it is also a record of the care a physician gave so it is a physician record too, Hood explains.
Giving patients the power to change data is really a paradigm shift, adds Sidna Tulledge-Scheitel, MD, medical director for Mayo Clinic Global Products and Services. "I'm a physician and we get a little bit centric about everything occurring in the office, but people are living 99% of the time outside of the doctor's office so I really believe in having health information and guidance and reminders where people are at," she says. "Right now we don't have mobile capabilities with the application, but we are going to be moving in that direction."
Prioritize health information technology. "I focused on the internal organizational work first," says Boyer. "A lot of CIOs still need to focus on an EMR." Once facilities have that EMR, they can determine how to pull together the data for a continuity-of-care record and start planning the data repository that will be needed to house the CCR, she says.
Determine patient priorities. PHRs cannot be generic. They have to incorporate elements that are critical to an individual's health, says Boyer. Both Mayo Clinic and NewYork-Presbyterian developed PHRs that help patients interpret data. NewYork-Presbyterian's PHR also alerts patients if they pick a weak password.
Patients with chronic conditions may be the more compelling users early on, but there are benefits for healthy people, such as having access to medical information and baseline data regardless of where they are, says Tulledge-Scheitel. "Having the ability for it to be very portable and not tethered to an entity—employer, insurance plan, or hospital—we believe is essential because people are highly mobile today."
Hospital and public health officials who worry about being deluged this fall by sick and worried well patients fearing H1N1 now have comforting federal guidance on how to re-direct crowds without violating the law.
First, jammed hospital emergency departments can set up alternate screening sites elsewhere on campus, with personnel stationed outside the emergency department to log in and redirect patients seeking care to that alternate site.
This triage system is acceptable as long as the personnel are qualified physicians, RNs, physician's assistants or nurses trained to perform such exams.
Second, hospitals may set up screening at an off-campus site if it is controlled by the hospital. And hospital and community officials may encourage the public to go to these sites instead of the hospital for screening for influenza-like illness.
Third, hospitals and community health officials may encourage the public to go to those sites instead of the hospital for influenza screening.
And fourth, the required medical screening exam does not need to be an extensive work-up in every patient's case.
The guidance was issued in a fact sheet distributed to hospitals by the Centers for Medicare and Medicaid Services in response to hospital and agency concerns.
However, there are some important caveats.
A hospital may not tell individuals who have already come to the ED to go to the off-site location for the exam. And the hospital cannot announce or advertise the off-site location as a place that provides care for general, urgent, unscheduled emergency medical conditions, other than those involving influenza-like illness.
Hospital and public health officials concerns stem from requirements under the federal Emergency Medical Treatment and Labor Act (EMTALA). The law says hospital emergency rooms that participate in the Medicare program must provide medical screening exams to any patients who arrive at their doors, regardless of the patients' ability to pay.
If patients have an emergency medical condition, the hospital must treat and stabilize the patient within its capability or transfer to a hospital that does have the capability and the capacity to do so. Receiving hospitals with appropriate capabilities and capacity cannot refuse those transfers.
But in recent months, hospitals, state health departments, and federal emergency agencies wrote and called CMS and "expressed significant concerns" about their ability to comply with legal requirements in the event of an H1N1 surge, according to a CMS memo from Thomas Hamilton, director of CMS' Survey and Certification Group, in a memo sent to hospitals nationally.
"Many stakeholders perceive that EMTALA imposes significant restrictions on hospitals' ability to provide adequate care when EDs experience extraordinary surges in demand," he said.
Hamilton's memo clarifies the law, spelling out several options that are permissible under EMTALA, "to reassure the provider community and public health officials that there is existing flexibility under EMTALA."
Matt Wall, associate general counsel for the Texas Hospital Association, said his group was one with concerns about how it would manage a widespread outbreak of illness. But, he said, this memo "clarified" the rules and reassured his organization.
"One of the beneficial aspects of this memo was the explanation that on your hospital campus, you can set up alternate screening sites. And this will help relieve some of the overcrowding in the actual emergency department," he said.
The other bit of relief came in guidance that hospitals and public health officials can "publicly recommend and encourage the public to go to an off-campus site that is controlled by the hospital. That will help relieve some of the bottlenecks in the emergency departments too."
Hamilton's fact sheet also noted that communities may set up screening clinics that are not under the control of the hospital, and those sites are not under EMTALA obligation. However, a hospital may not tell individuals who have already come to their emergency departments to go to the off-site location.
A spokeswoman for the Texas hospital group, Amanda Engler, says the organization is happy that CMS "is addressing this situation earlier rather than later."
CMS' fact sheet did not address what hospitals should tell people who call the hospitals asking where they should go.
In California, spokesman for the state Department of Public Health, Ken August, notes that worries about how to triage patients in the event of an H1N1 scare this fall has not been an issue, and California was not one of those states with significant concerns.
"For us, disasters and other emergencies come annually, whether they are earthquakes, wildfires, or floods, so this kind of a question has been raised many times before," August says. In California, state law allows public health officers in each county great latitude to be flexible with rules governing such situations, he says.
CEOs will want to talk to their emergency management coordinators and infection preventionists about plans to handle a predicted spike in H1N1 swine flu and seasonal flu cases this fall.
Federal health officials recently held a conference call with hospital planners to discuss H1N1 response efforts.
Patient surges in ERs and ICUs are likely complications hospitals will need to handle, even if the H1N1 strain remain relatively mild, said Nicole Lurie, MD, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services.
Lurie and others offered five tips for CEOs and hospitals to stay ahead of H1N1 and seasonal flu cases in the community:
1. Evaluate your sick leave policies.
Department managers and the human resources office should have mechanisms in place to track employee absenteeism rates daily should an H1N1 or seasonal flu outbreak occur, health officials said.
Hospitals also need to review their sick leave policies in light of the H1N1 pandemic, said Jeff Hageman, an epidemiologist with the Centers for Disease Control and Prevention (CDC). This is an important interim recommendation from the CDC that hasn't received as much attention as other recommendations.
Employees who contract the flu may either need to stay home to recover or not show up to work if they're fearful or have ill family members.
The CDC recommends that in communities with H1N1 outbreaks, healthcare workers who become ill with the flu remain away from work for seven days or until the symptoms have resolved, whichever is longer.
Traditionally, many healthcare workers will come into work with flu symptoms, so such behavior is a real threat this fall, said Tom Michaels, an infection preventionist at Health Partners Medical Group, a physician group with locations throughout northwest Indiana and southwest Michigan.
Don't forget to check in with your contractors to find out how their sick leave policies might affect the hospital's day-to-day operations and supply chains, Hageman said.
2. Pay attention to clinics and physician offices.
Expect the first signs of trouble with H1N1 to occur in these settings, and with that in mind educate employees there, Michaels said.
This spring's first H1N1 wave hit Health Partners Medical Group's clinics the hardest, not the group's affiliated hospitals, he said.
3. Determine proper access points into the building.
Talk to security directors about how to ensure access control into the hospital during an outbreak, which is another important concern that hasn't been in the spotlight, Hageman said.
The CDC recommends hospitals post signs at entry points instructing patients and visitors to notify staff members if they have flu symptoms. Limiting points of entry into the building is also suggested in communities where outbreaks are occurring.
4. Keep close ties with your vendors.
Given that supplies of N95 respirators and other personal protective equipment is finite, hospitals need to know what suppliers they deal with and how quickly those vendors can stock resources, including medical gas, health officials said.
The Joint Commission requires hospitals to keep a documented inventory of resources and assets on hand that could be used during an emergency response such as a pandemic.
5. Prepare to inoculate staff members.
At this point, we all know the various reasons the majority of healthcare workers do not obtain their annual flu shots.
Once the H1N1 vaccine becomes available, CEOs may need to push for greater employee vaccination rates. "Are you prepared now to vaccinate all of your frontline healthcare workers when the vaccine becomes available in your state?" Lurie asked.
The federal government will make the vaccine available to providers for free, and health officials have indicated the Medicare program will cover the administration fees associated with the vaccine, Lurie said.
More than $25.7 million in grants will be distributed to improve health and support services at health centers nationwide, Health and Human Services (HHS) Secretary Kathleen Sebelius announced this week during the National Association of Community Health Centers' annual meeting in Chicago.
"These grants could not be coming at a better time," Sebelius told more than 2,000 meeting attendees. With more than 14.5 million Americans out of work and 47 million without health insurance, "the health centers are seeing more patients now than ever before."
The health center system, with is overseen by the HHS' Health Resources and Services Administration (HRSA), served more than 17 million medically underserved people in 2008--up from 10 million patients just eight years ago. Since the recession began, the population of patients using the centers has jumped by another one million people--a third of them children, according to HRSA.
The centers are to receive 180 grants worth more than $21.9 million, which will add or increase mental health/substance abuse programs, oral health or pharmacy services, or "enabling" services, such as outreach, transportation, and case management services.
Also, 48 planning grants totaling more than $3.8 million are to be distributed to organizations in underserved areas that do not have health centers as a way to help them develop new service delivery sites. These new health center sites will be required to meet federal requirements for governance, community involvement, quality of care, and financial feasibility.
HRSA's Health Center Program currently funds a network of more than 1,100 community, migrant, homeless, and public housing health center grantees nationwide. These organizations, in turn, provide healthcare services at more than 7,500 clinical sites, ranging from large medical facilities to mobile vans.
Many of the health centers earlier this year were recipients of a one time investment under the American Recovery and Reinvestment Act. As one of the first recipients of stimulus funding, the centers received $338 million in "Increased Demand for Services" grants that were designed to help health centers adjust to more patients needing their services.
Compared with the swath of healthcare businesses spread out on either side of Interstate 95 from New York to Washington, tiny Danville and Riverside, PA, at first glance don't seem to have much to offer that industry. But the two hamlets, across the Susquehanna River from each other about 150 miles northwest of Philadelphia, are homes to organizations trying to spark a boom in healthcare innovation in rural Pennsylvania.
Surprising as it may seem, house calls may offer a path toward the elusive goal of providing better medical treatment at lower cost. And although the proposal has generated fewer fireworks than the proposed new government insurance plan, experts say it may help transform the nation's healthcare system. Lawmakers on Capitol Hill are poised to make house calls a building block of President Obama's promised healthcare overhaul.
Swine flu could infect half the U.S. population this fall and winter, hospitalizing up to 1.8 million people and causing as many as 90,000 deaths, which is more than double the number that occur in an average flu season, according to an estimate from a presidential panel. The virus could cause symptoms in 60 million to 120 million people, more than half of whom might seek medical attention, the President's Council of Advisors on Science and Technology estimated in an 86-page report assessing the government's response to the first influenza pandemic in 41 years.
