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Physicians: Sermo allowing docs to discuss chart errors about them! by Matthew Holt

Sermo got some press this week about a thread that’s of lots of interest to all of us–medical errors and inaccurate records:


Several years ago, Botney visited a specialist to check out a
bothersome lump in his cheek. He took some medicine and the problem
went away.Out of curiosity, Botney thumbed through his chart and was
surprised to find a note from the doctor saying he had a stroke."I
never even had the symptoms of a stroke. No visual changes, no
weakness, no numbness, nothing," Botney, an anesthesiologist at Oregon
Health & Science University, said in a telephone interview from
Portland.

The key difference here is that
physicians were talking about this with other physicians. The next
question is whether this will blossom as an issue because it’s now
being talked about online? Or will it get hidden under the medical
carpet as has been the issue of medical errors for all these years?

Also worth noting that one of the leading docs in the patient safety movement, Bob Wachter, has a new-ish blog out too that’s well worth a look. I’m happy to report that Bob is also now a contributor at THCB. If you haven’t yet, immediately sally forth and read his recent posts "Dennis Quaid’s Kids – Are VIPs Safer?" and  "When is a Medical Error a Crime." Both have interesting comment threads developing.Comment on this post at the Health 2.0 Blog

 

Health 2.0 Second Life–maybe I can be convinced, by Matthew Holt

Despite all the hype, I’ve been very down on Second Life.  I’ve downloaded the app, logged on, blundered
around and never figured out how to make it work. I spent my first 4
goes trying and failing to get off the first island where you’re supposed to do a series of tests. There’s no
tutorial, no clear explanation of how to make your avatar move around,
and almost no help. That’s why despite 2 million downloads only some
30–50,000 people seem to be regular users.

But despite that, I managed to be introduced to some people with
various disabilities and various conditions who were using Second Life.
Last week I logged on with their help and met them. They helped me
teleport over to their island, and they spoke with great hope and
expectation about the power they felt that Second Life gave people who
had problems leaving the house, meeting others, and generally dealing
with some of the every day activities of daily life.

I’ll tell you more as this goes on, and as I get permission to share
more. But perhaps I can be convinced that the problems Second Life
gives the initial user can be overcome. And perhaps something very
valuable can be created there that has very positive health benefits.

Comment on this post at the Health 2.0 Blog

HOSPITALS: Dennis Quaid’s Kids – Are VIPs Safer? By Bob Wachter

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Robert_wachterRobert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Robert Goldman, he coined the term "hospitalist" in an 1996 essay  in The New England Journal of Medicine.  His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as "an epidemic" facing American hospitals. His posts appear semi-regularly on THCB and on his own blog "Wachter’s World."
The Entertainment Blogosphere was atwitter this week with the story
of actor Dennis Quaid’s twin
newborns, who reportedly received a
1000-fold heparin overdose at Cedars-Sinai Medical Center in La La
Land. Cedars’ Chief Medical Officer Michael Langberg may win this
year’s Oscar for fastest public apology – having learned the lesson
from the 2003 Duke transplant error, where the hospital stonewalled for a week or so, adding chum to the media feeding frenzy.

The
error came during heparin line flushes, when a 10,000 units/ml solution
of heparin was mistakenly substituted for the intended 10 units/ml
solution. Although the cases required pharmacologic reversal of the
anticoagulant effect, thankfully there were no bleeding complications.

These cases come on the heels of last week’s report
out of Dallas that the state-supported UT-Southwestern kept an “A-list”
of potential donors and assorted bigwigs. Apparently, when these folks
come to the hospital or clinic, they may get a personal greeting, a
preferential parking spot, perhaps even an escort to their appointment.
My friends at Health Care Renewal, who chronicle and condemn healthcare’s corporate influences, were shocked. Shocked!

I’m
not. Every hospital I know keeps some sort of a VIP list, a tripwire to
alert the organization of the arrival of a dignitary or billionaire.
Even when there isn’t a formal list, you can be sure that a single call
to the CEO’s office is more than enough to lift the velvet rope. That’s
a simple fact of life, and to me not worthy of a big fuss.

Continue reading…

TECH: An appeal for help on visualization software

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An old colleague writes to me from the land of multiple project coordination hell.

We’re managing about 60 concurrent projects in just one of our teams, and dozens of other concurrent projects with other teams.  We’re rapidly becoming victims of our own success as we receive funding for more and more concurrent projects. We’re looking for better options for visualization software for how to provide quick, useful views of multiple dimensions of each project both for our program management perspective, as well as from the perspective of packaging information for our executives.  In the past, you have reviewed this space, and I just wondered if you could recommend a few products that might help us manage this space.  thanks for any help on this topic.

I haven’t looked at this space in some time, but if you have any suggestions please put them in the comments!

POLICY: The Times’ editorial leaves me baffled

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I for one remained baffled about what’s happening within the gizzards of the Grey Lady. On Sunday the NY Times published presented a long editorial about American health care and its high costs.

After the dog sore licking episodes of last year, (hinted at in the "does this matter?" section of this editorial when they dare to say "By some measures, Americans are getting good value.") this year the NY Times has had some sensible columns and has highlighted Wennberg’s work.

The editorial is a hodge podge of mostly correct analysis without any real "editorial" as to what to do. I’m baffled. Most of us would largely agree with their diagnosis but I’m confused as to what they’re suggesting here. The final paragraph bears repeating for being total woffle

By now it should be clear that there is no silver bullet to restrain soaring health care costs. A wide range of contributing factors needs to be tackled simultaneously, with no guarantee they will have a substantial impact any time soon. In many cases we do not have enough solid information to know how to cut costs without impairing quality. So we need to get cracking on a range of solutions.

I long for the halcyon days of 1992 when the NY Times more or less supported managed competition. There are plenty of things we could do (managed competition properly implemented is one, single payer is another, extending the VA to all Americans is a third). All of those policies would do something to contain costs. Now I’m a realist and I know we’re not going to do any of those–but this piece is supposed to be an editorial, fer chrissakes! Can’t they support something?

This editorial was clearly written by a committee that either didn’t understand the solutions or doesn’t agree about them.

PHARMA: Shocking revelations

Says here (“here” being a long mea culpa article by a psychiatrist and former agent of Wyeth in the NY Times) that some doctors get paid by drug companies to give talks to other doctors about drugs, and that not only do they use studies that make those drugs look better than others, but that if they start pointing out the flaws of their sponsors drugs in their talks, then the money dries up.

My word…

I guess repeating a point is OK. But it’s not as if John Abramson, Marcia Angell et al haven’t beaten this to death. Yup, we can’t trust doctors not to be both naive and greedy (as the NY Times correspondent points out).

But there are two counterpoints. First is the informal one from other doctors, such as the newsletter that the physician in question now puts out, debunking dodgy research. I think we’re going to see much more of this in the future.

The second unfortunately we’re going to have to wait for—that is purchasers getting serious about physicians’ use of certain drugs when it’s clearly not medically appropriate. And despite lots of clear evidence about that, we’re still waiting. Blaming the drug company for taking advantage is still pointing the finger in, mostly, the wrong direction.

Of course we’ve had this little argument on THCB many times before.

POLICY: The liberal media maliciously tells the truth about Rudy, again

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There’s more Giuliani bashing going on in the liberal media. First in the NY Times Frank Rich goes after him via the seedy route of the forthcoming tell-all lawsuit from Bernie Kerik’s ex-girlfriend. (It’s good stuff–I’d recommend a full read). Now the LA Times‘ Ricardo Alonso-Zaldivar points out the modest fact that cancer patients who would luxuriate in Rudy’s free market health care concept would not (and cannot in most of today’s American health care) guarantee that they would get access to health coverage or of course the care that Rudy is so happy about. In fact the American Cancer Society has been feeding Bob Herbert a steady series of terrible stories of cancer patients who got financially and medically shafted by the current system.

Of course Rudy was at the time of his cancer treatment enjoying socialized insurance, at least insurance socialized across the group known as NY City employees. Of course since 1970 he’s largely been a Federal or city employee, so apparently social insurance is OK for him, if not for the rest of us.

And all of this is a great pity. As David Brooks suggests, there have been times when Rudy was not merely playing to the most unthinking elements of the conservative primary voters. Maybe we’ll see that again if he wins the Republican nomination, but he’s giving the Democrats plenty of ammunition for the general election.

CODA Uwe has a great zinger about Giuliani’s use of the socialized medicine system he controlled to help out an old friend in a letter to the NY Times Saturday.

And the Health 2.0 Design Award Goes to … by Indu Subaiya

I’d
like to dedicate my Thanksgiving post to the people who are working on,
have worked on and most importantly, ought to be working on issues of
design and usability in healthcare.

I seem to be joined by Sohrab Vossoughi, Founder of Ziba Design who wrote a viewpoint article in this week’s Business Week, Designing the ‘Care’ into Healthcare.

What do I mean by design? To quote Joan Osburn, who runs Osburn Design,
a well-known architecture and design firm in San Francisco, with her
husband Steve, "design is not decoration." Design to me is a philosophy
and an intentionality behind creating things, be they physical
structures, gadgets, websites or services, that translate into an
optimal user-experience. Optimal, in turn, has elements of both
functionality and beauty i.e., (1) were you able to do what you needed
to do and, (2) did you enjoy doing it?

    > Continue reading this post on the Health 2.0 Blog

HEALTH 2.0: In mourning, meanwhile over at Health 2.0 Blog

Like every proud American I’m spending the day paralyzed by the effect of way too much excellent food and wine yesterday. And like every other Englishman (ex-pat or Blighty-based) I’m also mourning the national team’s appalling performance in losing at home to the mighty Croatia and hence missing out on going to the European Championships finals next summer.

So while THCB sleeps forlornly over the weekend, Health 2.0 Blog is up and humming with Indu Subaiya’s superb thanksgiving for excellent design in health care.

POLICY: Someone else beats up on Herzlinger

Here’s Maggie’s takedown of Herzlinger’s WSJ column, with a heavy dose of Uwe included. And as far as I can see the most important thing about any regulated individual insurance system is consistency of benefits across plans—which means the plans then have to concentrate on improving care rather  than gaming risk selection. And then there’s risk adjustment between them. (At least that’s the original Enthoven model).

I haven’t felt the need to torture myself enough to read the latest Herzlinger book—given that I suffered through the previous two, I awarded myself time off for good behavior. However, she appears to want to allow plans to offer personalized benefits “for consumer choice” and then somehow do back end-risk adjustment between them later. Funnily enough that’s roughly what Wellpoint’s California lobbyist said when I asked how they justified selling Tonik et al. At the least it sounds very complex (after all, risk-adjustment between plans with identical benefits is hard enough), and in reality it’s probably just more destruction of the risk pool.

So in other words the part of Switzerland that does work (the uniform benefits) is the part that Reggie wants to destroy. No doubt Maggie will be looking forward to lots of incoherent comments and accusations of plagiarism and poor research skills on her blog.

assetto corsa mods