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TECH: Christiana hospital knows where you are

All the staff, patients, physicians and everyone else in the ED in Christiana hospital  (in Delaware) is now tracked everywhere they go…and it works — but no staff tracking in the break room or bathroom. But quite a few tracker badges get stolen by paranoid patients! (They lost 600 badges @ $90 each(!) in the first year from staff and patients, but now it’s going down) This is the future and it really helps with workflow through the system.

Very interesting talk from Linda Lakowski Jones, who runs trauma, ED and the helicopter service for the 800+ bed hospital — (please please never give me that job!!)

QUALITY/TECH: Bob Wachter on patient safety

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Bob Wachter is probably the leading expert in the nation on medical errors and a great speaker.

He’s worried about the lack of budget for training, and that IT = Patient safety. But he does think that the IT/EMR movement is now tipping, especially as the disconnect between patient’s perception of being high-tech and what’s happening in the health care system is not tenable, and docs saying that they can’t do it is not credible even for the older docs

He talks a little bit about computer induced errors and problems. There’s a new literature replacing the Bates stuff about how great the Brigham’s system was, and now it’s all about how it’s going wrong.  It’s not a mistake to computerize but you need to go in with your eyes open. You need to think about the process improvements…including the easy ability to cut and paste H&T and continuing on mistakes. What happened when the computer goes down? As at Beth Israel Deaconess. And then in the example for Childrens’ Pittsburgh, does CPOE kill people? Well the chaos still goes on and CPOE clearly gets in the way in ICUs. The critiques of this study are that they "didn’t do it right" but that’s what an implementation looks like. Plus what looks good in the demo doesn’t work per se in your local community hospital. Or the experience of the Brigham is not transferable …unless your hospital also has a 1,300 strong IT department.

The Cedars Sinai story: They built their own and they built in some decision support. But the medical staff revolted. Too many alarms, reminders, too many screens, etc, etc. But not just that, also a story about control over medical care.  Cedars was exerting central control.

So the question is, who exerts control. He quotes Spiderman. "With great power comes great responsibility"  Now there are institutions that are going to have to wrestle with this problem, and if you push too hard the backlash is very tough.  get it implemented first, and do the control later…one little thing at a time.  It’s like the Right Stuff which changed the test pilot from being a cowboy pilot like Chuck Yeager to being a goody two shoes Astronaut like John Glenn….it got more boring, but mortality rates fell dramatically. So this shift is coming too, and will be a huge shift.

Add to this the emergency dislocation of medicine, such as late-night radiology reading in Bangalore. This means that the world gets wired and we start to figure out how to provide care very differently. eICU from VISICU is another reason, seeing a real time data stream and facilitating the care remotely. One of the most profound affect is going to de-tether the assay from its interpretation.

TECH/QUALITY: Leapfrog

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I’m at a conference on patient safety…

Suzanne Delbanco is the CEO of the Leapfrog Group. This is the group which is where big employers get together to grouch about health care and ask the providers nicely to try to provide better care, cheaper, and suggest that they adopt some innovations like using computers–which of course get rebuffed. She thinks that "in this country we have a funny employer-based health insurance system".  So employers are moving to cost shifting, etc, etc, but they know that wont work.

So Leapfrog was started to try to improve the process, to make "leaps" in patient safety and quality. CPOE was the first not only because it was the gold standard for reducing errors but because it also required hospitals to put in the information systems that will enable process measurements. They’ve focused on inpatient setting, but are looking at outpatient eRx, lab tests, and care management prompts. Now as the base for Bridges to Excellence office link program.

They run their own online survey (voluntary and online) and license the data.

So how have they done? Well progress on CPOE has been slow. They think they’ve gone from 2% to 7%, and another 17% say they’re working on it.They are also creating a CPOE evaluation tool (something that HISTalk might want to get involved in)

She also asks is transparency enough? Well the AHRQ quality report showed improvement in nursing home care (15%) compared to only 3% in hospitals, because Medicare mandated reporting by nursing homes. Now CMS is quasi-mandating reporting by hospitals, so she expects that improvements will start showing up in hospital quality measures.

In addition P4P is getting closer to being standardized and less confusing, although not widespread…they are seeing more and more P4P, such as Bridges to Excellence. She’s also on the CCHIT committee that will be evaluating and later certifying products for the physician setting.

On the other hand I didn’t ask the nasty question which is given that
the employers have let their suppliers stick them with 15% annual
increases add infinitum why do they think that anyone is going to be
convinced by these efforts?

THCB: New feeds live!

After much tinkering and grumbling, THCB’s crack tech staff has set up new RSS feeds filtered by content category. This means you can now get Health Care Blog posts on specific topics delivered to your trusty RSS reader without having to look at everything. There are now individual feeds for pharma and technology. More categories will be added soon. 

BLOGS: Grand Rounds coming here for an end of year special

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I have finally been suckered into offered to host Grand Rounds, and will be doing so in the week between Christmas and New Year on Tuesday 27th December. And it’s likely that’s all I’ll be doing that week over here.

So to make it special I’m putting out a request for your best post of 2005–-the whole year. Please think about it and get it to me by the end of next week, that’s Friday 23rd.

TECH: EMR comments

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If you haven’t seen it in the last few hours, you should see what Kelly Clark (who started all this) has added to the comments on the EMR piece, and see the subsequent discussion. Continually really excellent stuff from all concerned, and no mention of a certain insurance product.

TECH: Bloggers chasing own tails on EMR

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Both the Health Care Law Blog and the Health Care IT Guy have follow ups on the long post here on EMRs and whether docs ever can love ‘em. I’ll say little more other than I feel a little like we’re in one of those Warner Bros cartoons where Tazzy is chasing his own tail….especially as this post now automatically appears over at Shahid Shah (The Health Care IT Guy)’s meta-HealthIT blog, the HITSphere….

But I’m not sure that I like Shahid’s take on my business model, and I’m not sure I like it either!

Isn’t the blogosphere and the Internet wonderful? It would take thousands of dollars and months to put together a focus group of professionals to get us this kind of input. Now, Matthew’s given it to us health IT guys for free. Thanks, Matthew

TECH: What? Were you expecting them to come out against it?

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How about this for vacuous press release of the week:

Cerner Technology to Support Participation in IHI’s 100,000 Lives Campaign; Healthcare IT Leader Supports Effort to Reduce Hospital Mortality Rates

But please, go read the press release and tell me what they’re actually doing other than putting out a press release saying that they think it’s a good idea. Still Neil Versel reports in that they have sponsored the pens at the IHI meeting, and it bought them a quote from renowned commie Don Berwick himself (even though Neal Patterson’s wife may not agree with his politics).

POLICY: Ignorance is not bliss

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Young punk Kate Steadman has a very interesting post about the uninsured over at Health Policy

The current display of ignorance was on the subject of being uninsured. The woman I talked with didn’t really understand what it meant to be uninsured until her housekeeper had a health problem and couldn’t get seen by a doctor.

Look down in the comments for a combination of ignorance and desperation, and you’ll see why this will end up the political topic of the next two decades, as I said in my Spot-on piece last week.

And a big Hat-tip to Derek Lowe who’s doing Grand Rounds this week.

POLICY: Another balanced debate–what did you expect from the WSJ editorial pages?

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So in this online "debate" about consumer health care called Consumer Choice: Can It Cure The Nation’s Health-Care Ills? the WSJ editorial page shows its lack of bias by having two HSA advocates, and one very tired liberal debunking them.  And Reischauer obviously couldn’t type as fast as the other two.

And no one mentioned the 80/20 rule, nor the RAND experiment that showed that needed care was forgone as often as un-needed care. And despite the fact that the two HSA loonies claim that we do not apparently ration by price, we have a huge rate of bankruptcies caused by medical bills, and huge numbers of the poor are unable to afford reccomended care or have trouble paying for care compared to poor people in other countries. But why bother using actual data published in peer reviewed journals when you can wax poetic telling lies about South Africa while ignoring what’s going on in Singapore. But it’s a "debate" so why sweat the small stuff?

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