In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance.
Physicians endured an orgy of judgment during their formative years – in high school, college, medical school, and in residency and fellowship. But then it stopped, or at least it used to. At the tender age of 29 and having passed “the boards,” I remember the feeling of relief knowing that my professional work would never again be subject to the judgment of others.
In the past few years, all of that has changed, as society has found our healthcare “product” wanting and determined that the best way to spark improvement is to measure us, to report the measures publicly, and to pay differentially based on these measures. The strategy is sound, even if the measures are often not.
The Joint Commission has issued a statement indicating that health care professionals should not text patient orders. It reads:
“It is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.”
I was alerted to this statement by an iHealthBeat article on the topic, which quotes a couple of experts who note that texting has security, privacy and reliability problems that make it unsuitable for critical issues.
I understand the downsides but I’d be interested to learn more about what’s driving the use of texting for orders — if there is in fact such a trend. My guess is that younger physicians in particular are used to texting in their personal lives, finding it convenient, immediate, reliable, concise and likely to be read, acknowledged and acted on quickly. Add to that the fact that texting can easily be done from personal mobile devices and the appeal becomes pretty clear.
Not content with handing out demerits for bad behavior, the Joint Commission has launched an effort to help those who misbehave change their ways.
As detailed in the Wall Street Journal’s Health Blog, the mission of the Joint Commission’s new Center for Transforming Healthcare will be, in the Journal’s words, “to work on new collaborative programs with leading hospitals and health care systems to find a cause of the most deadly breakdowns in patient care, and put a stop to them.”If the name of the new group sounds familiar, you could be confusing it with Newt Gingrich’s Center for Health Transformation. That center was launched by the former House Speaker to tout the benefits of health information technology and a changed reimbursement system and then show how those benefits could work in practice through demonstration projects. Of course, with the advent of the Obama administration, the for-profit center has changed its mission just a tad from Newt-the-Wonk’s, “Paper Kills” to Newt-the-Republican-Attack-Dog’s “Democrats kill.” Visitors to the Center’s site can now find helpful op-eds with titles like “Healthcare Rationing” and “Listen to Barney Frank or listen to America?”