Category: Uncategorized

Crowd Sourcing Comes Through Again

Mar 14, 2010• 5

By PAUL LEVY

I have written before about the incredible power of crowd sourcing, using the reach and scope of social networking on the Internet to solve a complex problem. Here’s a play-by-play about a difficult question. It demonstrates how the asynchronous participation of many participants inevitably converges on the right answer in less than 24 hours. You just have to be patient and let the truth emerge.

I posted the following problem on Facebook:

Query — what makes some Facebook status updates stay put on the top of your page until cleared, while others appear as one-time updates? (Yesterday at 12:22pm.)

Luba:

I think it’s an algorithm that has to do with how often you comment on other people’s posts. Facebook tries to be smart about which people you actually care about seeing. I often find it wrong and look at both top stores and most recent to get a full picture of what is going on.

It’s Not About Meaningful Use …

Mar 12, 2010• 73

By JOHN MOORE

With the impending comment deadline for Meaningful Use (MU) fast approaching, many organizations, from CHIME to AHA to AAFP and others are asking for some form of relaxation of MU criteria in the final version. Now it is not to say these concerns are not justified, it just may be that they are misplaced for the vast majority of those who currently do not use an EHR, small physician practices and clinics. It is within these small practices, which are really just small businesses, that the majority of patient care occurs and where possibly the biggest benefit may be derived in the use of EHRs. It is also here where we may find the highest adoption hurdles, and those adoption hurdles are not so much about MU criteria, but more about productivity losses in adopting an EHR.

This past weekend I spent some time with a nurse who works in a primary care/pediatrics clinic in Vermont. There facility, part of a network of several clinics, recently adopted and went live with a new EHR system (about 18 months ago). According to the nurse, this EHR, from one of the big names in ambulatory systems, has been a complete disaster for the clinic. Productivity is way down, countless glitches have occurred, whole system crashed during a recent upgrade and the list goes on. For 2009, this clinic, which has been in operation for a few decades, had its first ever loss last year, the year they went live with this EHR. The clinic puts the blame squarely on the EHR, which has severely constricted their ability to see patients and as all readers know, clinicians get paid for seeing patients, not trying to use a complex and difficult to use EHR.

It is stories like this that concern me.

This is a clinic trying to do the right thing, trying to use an EHR in a meaningful way (note, did not say meaningful use) and they are struggling. Yes, they do want to deliver the best patient care, but at the end of the day, they, like any business have bills to pay. They are losing money far in excess of what HITECH Act incentives will provide. This story is, unfortunately, not unique, though few EHR vendors will come clean on the productivity hit to a practice. Maybe instead of guaranteeing that their application(s) will meet MU criteria, EHR vendors should guarantee that the productivity hit of using their solution will not exceed HITECH incentive payments. Now that would be an interesting value proposition.

Thanks to Michael Jahn of Jahn & Associates for the MU cartoon.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

Program Director Healthcare IT

Mar 11, 2010• 3

Since its inception, the New England Healthcare Institute has been committed to the identification, assessment and promotion of valuable health care technologies with the potential to improve the quality of care while reducing cost. The Fast Assessment and Adoption of Significant Technologies (FAST) initiative, conducted in partnership with the Massachusetts Technology Collaborative, has been at the core of our work to promote innovation in health care and, among others, has resulted in the identification of computerized physician order entry (CPOE) and tele-ICU programs as key elements of health information technology policy at the private, state and federal levels.

Position Summary

NEHI is seeking a Program Director – Technology with rich experience in the health care technologies to play a critical role in the continued development of NEHI’s portfolio of health care technology projects. As health care technology receives greater attention for its ability to significantly improve health care quality and lower costs as part of state and national health reform effort, the Program Director – Technology has the opportunity to catapult the promise of FAST to the national stage and brand NEHI as a national thought leader in the advancement of promising, underused innovations.

This is a full-time position and an outstanding opportunity for candidates with strong health information technology experience to work with senior leaders from all across the health care community to drive change in a fast-paced, team-oriented environment. Ideal candidates bring a blend of skills – problem solving, intellectual curiosity, collaboration – to their work at NEHI. Download job description. (PDF)

Verb-alizing

Mar 11, 2010• 7

By BOB WACHTER

One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.”

Say whaa?

I’m pretty sure that the most valuable thing I’ve done in my 15 years running UCSF’s inpatient service has been to convince the hospital to hire a discharge scheduler, Yolanda Jones, a delightful woman with a big smile and the world’s most thankless job. When a patient is ready for discharge, the interns send Yolanda a note with a list of follow-up appointments, radiology studies, and other outpatient tests that need to be scheduled. She makes all the appointments, then calls the patient and intern with the info. Our hospital would cease to function if not for Yolanda; she is the unsung hero of the medical service.

And now, the process of asking Yolanda Jones to schedule discharge appointments had become a verb.

RememberItNow! and Prezi

Mar 11, 2010• 4

By MATTHEW HOLT

RememberItNow! is a feisty little start-up that’s aiming at the medication reminder/management space. I like the feature set and the approach, and I hope the Pam Swigley the engaging CEO gets some traction. It’s launching officially on Friday

But what I really like is their use of this cool presentation software called Prezi to give their demo. So to kill 2 birdies with one stone, here it is — click the arrow and enjoy.

RememberItNow! Overview on Prezi

Innovation, Not Legislation: Venture Capital is the Path to Improving Patient Safety and Reducing Waste and Error in the U.S. Healthcare System

Mar 10, 2010• 24

By Lisa Suennen

All eyes are on Toyota’s recall of 8.5 million vehicles due to faulty gas pedals and brakes. The recall has sparked congressional hearings, a probe by the U.S. Department of Transportation, possible criminal charges stemming from a federal grand jury investigation and numerous civil lawsuits, all in the name of driver safety.

This aggressive response to Toyota’s mistakes is appropriate, even though the human toll from its miscues has been, thankfully, relatively modest – 34 alleged deaths and a few hundred injuries. Not to downplay this misery, but in stunning contrast, consider this: More than 100,000 Americans die annually in U.S. hospitals because of avoidable medical errors, according to the Institute of Medicine (IOM), which also says that medical errors rank as America’s eighth leading cause of death. This is higher than auto accidents (about 45,000) and breast cancer (about 43,000). And the problems don’t end here. Studies show that approximately 19% of medications administered in hospitals are done so in error, injuring about 1.3 million each year, according to the FDA.

Stressed Out System

Mar 10, 2010• 86

By ROB LAMBERTS

I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.

My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”

Expensive? A $20 copay is expensive? Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care. I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach. I see a lot of this too.Continue reading…

Hospital Quality Group Obscures Hospital Quality Reports, Journalists Charge

Mar 9, 2010• 16

By MICHAEL MILLENSON

The Joint Commission, which accredits four-fifths of the nation’s hospitals, is being accused of misleading consumers about the quality of care at those hospitals and then ignoring suggestions on how to correct the problem.

“The organization that accredits hospitals around the country, and voices support for transparency about hospital quality, has a Web site that obscures the reality of many hospitals’ performance,” said Charles Ornstein, president of the Association for Health Care Journalists (AHCJ) and a reporter for the public-interest journalism group ProPublica . In a March 1 letter sent to Dr. Mark R. Chassin, the Joint Commission’s president and CEO, Ornstein noted that not only has the group not addressed the “navigational issues” raised by AHCJ more than two years ago, but problems that make the commission’s QualityCheck site even less useful have cropped up.

For instance, that “Gold Seal of Approval” for your local hospital? Perhaps it should be called a Gold Seal of Possible Approval. Says the AHCJ: “[It] is misleading because hospitals with conditional accreditation or preliminary denial of accreditation still receive the same gold seal as fully accredited facilities.”Continue reading…

What Happens Next in MA?

Mar 9, 2010• 7

By PAUL LEVY

What happens next in Massachusetts with insurance reimbursement rates now that many of the facts and figures have been made public?

Here’s what I see. The dominant parties in the state on whose watch the disparities in the marketplace have taken place — Blue Cross Blue Shield and Partners Healthcare System — face financial and political problems, respectively. The PHS rates that are so much higher than others’ cause a major financial drain for BCBS. They do so in the short run just by the degree of current utilization. The effect is compounded over the long run, though, as PHS has a competitive advantage vis-à-vis other systems in recruiting community-based doctors and thereby brings more and more referrals into its hospitals. That these differentials have now been made public by the state creates a political embarrassment for PHS, which has often asserted that its creation brought about substantial economies of scale through integration of care.

I suspect that these factors will lead to a negotiated agreement between BCBS and PHS, where PHS takes a bit of a haircut in its current reimbursement contracts. Not so much that it dramatically affects the PHS bottom line, but enough so that both parties can say that they have cooperatively acted to slow down the rate of health care spending in the state. Will the new rates be anywhere near the statewide average? No way. Will they do anything to offset the competitive advantage that PHS has had or will continue to have? No.