Month: October 2014

The Rx for ICD-10 and the Threat of Inaccurate Documentation

Oct 27, 2014

By MICHELLE ZEIGLER

With ICD-10 still looming and value-based payments and penalties on the horizon, U.S. hospitals need strategies to tackle the “triple threat” of financial, operational and clinical challenges these transitions present. Summit Health implemented an end-to-end clinical documentation improvement process to address all three main challenges holistically.

In healthcare, we know it’s better to be proactive. Reducing stress, watching your diet and exercising to prevent a heart attack is a proactive approach instead of undergoing a triple bypass after the attack hits. Doctors see warning signs, like high cholesterol and blood pressure, take proactive measures and put patients on a care plan to prevent a cardiac event. For Summit Health, the ICD-10 requirement was our warning sign and the reason we took proactive measures early on. We knew we had to take dramatic steps to not just meet ICD-10 requirements, but to also prepare for the inevitable and much-needed transition to a value-based system that could significantly impact our bottom line. To stay ahead of the game, we charged forward with a vigorous, preemptive strike to ensure our clinical documentation process set up to succeed in any payment model and any number of coding changes.

Expect big things from YOUR AHA Scientific Events. You Ask. We Listen. We Deliver.

Oct 27, 2014

By ELLIOTT ANTMAN, MD

The American Heart Association is constantly looking for new ways to improve upon our scientific conferences. So, we are proud to announce the new AHA Scientific Meeting tagline: Expect big things from YOUR AHA Scientific Events. You Ask. We Listen. We Deliver.

What does this new tagline mean to the thousands of healthcare professionals who attend our AHA scientific events? It is our promise to the global cardiovascular healthcare community that we are listening to what you have to say. We promise to deliver enhancements that will make our scientific meetings convenient and mobile-friendly, while offering what the American Heart Association has always been known for: presentation and discussion of the very best in cardiovascular science.

So I encourage you to comment on our scientific meetings and we will continue to deliver results. I look forward to seeing you all at Scientific Sessions 2014 in Chicago, from November 15th-19th.

Learn more and register at scientificsessions.org.

Health IT Highlights from the Past Week

Oct 27, 2014• 3

By MICHELLE NOTEBOOM

If First You Don’t Succeed

Amidst recent criticism that ACOs are failing to control costs, HHS announces an $840 million initiative designed to improve patient care and lower costs. The Transforming Clinical Practice Initiative will provide 150,000 clinicians with incentives and tools to “encourage doctors to team with their peers and others to move from volume-driven systems to value-based, patient-centered, and coordinated health care services.” Sounds a lot like the goal for ACOs, which HHS hoped would help providers to “work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth.”

DeSalvo and Reider exit the ONC

Karen DeSalvo, MD, the national coordinator for health information technology for HHS, steps down from her post just 10 months into her job to assume the role of Acting Assistant Secretary of Health to address “pressing public health issues,” including the Ebola outbreak. The same day Deputy National Coordinator Jacob Reider, MD announced that he would also leave the ONC at the end of November. The ONC’s COO Lisa Lewis will serve as Acting National Coordinator. The changes comes at a time when critics are asking tough questions about the government’s Meaningful Use program and providers’ lackluster progress qualifying for Stage 2.

Epic, Ebola, and (legal) Payola

Epic President Carl Dvorak stands behind his company’s EMR and blames Texas Health Presbyterian clinicians for the mishandling of the country’s first Ebola patient. Meanwhile, the health system’s Chief Clinical Officer Daniel Varga, MD tells a Congressional committee that his organization is “deeply sorry” for “mistakes.” In unrelated Epic news, the company discloses it spent $24,000 over the last two months lobbying Congress. Epic is in the running for the Pentagon’s $11 billion EMR contract and fighting criticisms that its platform lacks interoperability.

Did CDC laxness on one infection help spread another?

Oct 25, 2014• 6

BY MICHAEL MILLENSON

There’s an infection that afflicts thousands of Americans yearly, killing an estimated one in five of those who contract it, and costs tens of thousands of dollars per person to treat. Though there’s a proven way to dramatically reduce or even eliminate it, the Centers for Disease Control and Prevention (CDC) inexplicably seems in no hurry to do so.

Unlike Ebola, this infection isn’t transmitted from person to person, with the health care system desperately racing to keep up. Instead, it’s caused by the health care system when clinicians don’t follow established anti-infection protocols – very much like what happened when Texas Health Presbyterian Hospital encountered its first Ebola patient. That hospital’s failure flashes a warning sign to all of us.

The culprit in this case is called CLABSI, short for “central-line associated bloodstream infection.” A central line is a catheter placed into a patient’s torso to make it easier to infuse critical medications or draw blood. Because the lines are inserted deep into patients already weakened by illness, an infection can be catastrophic.

CLABSIs are deadlier than typhoid fever or malaria. Last year alone they affected more than 10,000 adults, according to hospital reports to the CDC, and nearly 1,700 children, according to an analysis of hospital discharge records. The infections also cost an average of nearly $46,000 per patient to treat, adding up to billions of dollars yearly.

At one time, CLABSIs were thought to be largely unavoidable. But in 2001, Dr. Peter Pronovost, a critical care medicine specialist at Johns Hopkins, simplified existing guidelines into an easy five-step checklist with items like “wash hands” and “clean patient’s skin with an antibacterial agent.” Hopkins’ CLABSI rate plunged.

Is It Possible to Catch Ebola From the Media?

Oct 24, 2014• 30

By JOHN IRVINE

That pesky Ebola bug is not done with us yet.

Apparently not satisfied with inflicting havoc in Texas for two weeks and causing a major panic, the publicity-hungry Ebola virus set its sights on the media capital of the world on Thursday.

The latest Ebola case is a New York City Doctor. A specialist in international medicine at New York Presbyterian Hospital, Dr. Craig Spencer had been working with Ebola patients for the French relief agency Doctors Without Borders.

New York City health officials are conducting contact tracing to find people who may have had contact with Dr. Spencer.

The bad news?

New York City being New York City, Spencer took the the subway from his apartment on West 143th street in Harlem to a Brooklyn bowling alley the night before his fever spiked. That’s led to speculation that he may have inadvertently exposed a lot of people. Public health health officials are now tracing Spencer’s contacts to find potential “high risk” cases.

Our talking points:

Is It Possible to Catch Ebola on the Subway?

No. Yes. Maybe.

Unfortunately, in reality we don’t know, although we’re pretty sure we do. Current CDC guidelines are based on the assumption that Ebola only becomes contagious when symptoms present and the patient enters the high fever stage.

Via Controversies at Hospital Infection Prevention:

Those at risk for Ebola are healthcare workers who have cared for Ebola patients (whether here or in West Africa). Not mall-goers, bowlers, subway riders, or those who might have been in an airport terminal on the same day as an asymptomatic Ebola patient. The greatest transmission risk is borne by those who provide direct care for Ebola patients during severe illness, when viral shedding is very high.

There’s a lot of evidence to support this argument. There have been cases of symptomatic Ebola patients traveling by airplane, bus and other modes of transportation without spreading the disease. That’s somewhat reassuring.

On the other hand, it is not exactly compelling statistical evidence of anything other than that some people travelled with an Ebola patient and did not develop Ebola.

We need to work with much larger numbers before we know for sure. The good news?

Now that Ebola has arrived in a city of eight million people, we’re now going to have them.

Bayer’s Head of Innovation and Tim Kelsey of the NHS to Keynote Health 2.0 Europe

Oct 24, 2014

By HEALTH 2.0

The Middle East Marketplace, Medical R&D, Investments, and Consumer: Kemal Malik, Head of Innovation at Bayer, and Tim Kelsey, National Director for Patient and Information for NHS England are slated to keynote the upcoming 5th Annual Health 2.0 Europe conference on November 10-12 in London, UK. The international digital health conference will feature a wide variety of sessions on some of the most important topics in digital health including:

Medical R&D: How medicine continues to grow with Health 2.0 tools which supports medical research and collaboration via open data reporting and collection through clinical trials. Featured demos include F1000, Lumos!, PxHealthCare, and TrialReach.

Big Data: A session that frames national, entrepreneurial, and patient-based efforts to create Open Data portals and access across the spectrum. See how HealthUnlocked, Healthbank, and Marand are turning big data into actionable change.

Wearable Technology: As the marketplace for consumer tech and wearables become more prevalent within digital health, Health 2.0 Europe features devices from Biovotion, Qardio, Empatica, and Sensoria which are taking new approaches to tracking, capturing, and analyzing personal health data.

DeSalvo Out as ONC Head, Moved to Ebola Fight.

Oct 23, 2014• 13

By MICHELLE RONAN NOTEBOOM

Karen DeSalvo, MD, the national coordinator for health information technology for HHS, is leaving her post to to address public health issues, including becoming a part of the Department’s team responding to Ebola. She took over as the ONC head in January, 2014.

The ONC’s COO Lisa Lewis will serve as the agency’s acting national coordinator.

HHS spokesman Peter Ashkenaz told THCB:

“HHS Secretary Burwell asked National Coordinator for Health IT Karen DeSalvo to serve as Acting Assistant Secretary for Health, effective immediately. In this role she will work with the Secretary on pressing public health issues, including becoming a part of the Department’s team responding to Ebola. Dr. DeSalvo has deep roots and a belief in public health and its critical value in assuring the health of everyone, not only in crisis, but every day.

Lisa Lewis, ONC’s chief operating officer, will serve as the Acting National Coordinator. However, Dr. DeSalvo will continue to support the work of ONC while she is at OASH.”

The transition comes at a time when critics are asking tough questions about the government’s Meaningful Use program and providers’ lackluster progress qualifying for Stage 2.

Ebola, EHRs, and the Blame Game

Oct 23, 2014• 11

By DEBORAH PEEL, MD

It’s time to think carefully and look at the large systems (human and technical), institutions, and individuals that contributed to Mr. Duncan’s death. Systems should be designed to protect people and prevent human errors. Certainly we rely on the healthcare system to improve our health and to protect our privacy, especially our rights to health information privacy.

Looking at the death of Mr. Duncan, the poorly designed Epic EHR was a critical part of the problem: the lack of clarity, poor usability, hard to find critical information, and no meaningful quality testing to ensure the system prevents critical errors contributed to his death and endangered many others. Why wasn’t the discharge of a patient with a temperature of 103 from the ER flagged?

EHRs are one of several critical systemic problems.

Current US EHRs were not designed or tested to ensure patient safety or privacy (patient control over the use of PHI for TPO). The Meaningful Use requirements for EHRs don’t address patient safety or ensure patients’ legal rights to control use of PHI. Let’s face it, the MU requirements were set up by the Health IT industry, not by a federal agency charged with protecting the public, such as NIST or the FDA. Industry lobbying resulted in industry ‘self-regulation’, which has failed to protect the public in every other sector of industry. Industry lobbying is another critical systemic problem.

Our public discourse also is a critical systemic problem. The 24/7 US media drives us to play the ‘blame game’—and look at what happens: it’s a sham. A massive public and social media exercise substitutes for a crucial scientific and ethical oversight process by government and industry to face or examine the systemic causes and key actors—both people and institutions. We end up with no responsibility being assigned or addressed. Or the media hoopla and confused thinking leads to the opposite conclusion: everyone and everything is responsible and blamed, which has the same effect: it lets everyone and everything off the hook. Either way, no one and no institutions are to blame.

Update on CDC Guidelines on Ebola Specimen Handling + Lab Testing

Oct 23, 2014• 1

By THCBist

In response to several reader questions on the CDC post on safe handling of Ebola and recommended lab procedures, the CDC got back to us with this update:

In the Ebola guidance for healthcare workers and specifically for Specimen Handling for Routine Laboratory Testing of persons under investigation (PUI) for Ebola disease , CDC reminds all laboratory personnel to consider all blood and body fluids as potentially infectious. The guidance further informs laboratory personnel that strict adherence to the OSHA bloodborne pathogen regulations and Standard Precautions protects laboratory workers from bloodborne pathogens, including Ebola. In this guidance, emphasis is placed on the OSHA regulation’s requirement for performance of site-specific risk assessments. These assessments should consider the path of the sample throughout the laboratory, including all work processes and procedures, to identify potential exposure risks and to mitigate the risks by implementing engineering controls, administrative controls (including work practices), and appropriate PPE to protect laboratory personnel. Implementation of these recommendations requires that there is designated staff that is trained, competent, and confident in performing risk assessments within their laboratories.

Continue reading…

The Great Checklisting of American Medicine

Oct 22, 2014• 23

By HANS DUVEFELT, MD

Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists.

From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s healthcare environment are more likely to bog me down and distract me than focus my attention on the essentials. I call them choke lists.

Re-reading “The Checklist Manifesto” by Atul Gawande, published in 2010, the year before my clinic implemented their first EMR, I am reminded of how much has changed since then.

How I work and where my attention is drawn has changed because of the minutia of Meaningful Use, Patient Centered Medical Home, Accountable Care and all the other new philosophies and forces that define primary health care.