THCB thanks our corporate supporters
InterSystems. Our technologies enable healthcare organizations to rapidly connect processes, applications and people – and clinicians to make decisions with complete information.
Learn more: visit InterSystems.com
Stop by today at #CHIME14 BPI showcase for @InterSystems & @NorthShoreLIJ
whitepaper on #caremanagement! http://bit.ly/1woIDIE
Send a message of support to THCB’s community: Become a corporate underwriter.
Like far too many women, I know what it means to confront the prospect of breast cancer. I spent the better part of a year in watchful waiting for what eventually proved to be a benign lump. Some of my friends participate in randomized clinical trials in hopes of being among the first to benefit from a promising new therapy. Some have passed away.
All have faced agonizing challenges sorting through options and confusing medical jargon, poring over statistical data they may or may not understand, and trying to reach a treatment decision in the midst of their fear.
A recent observational study reported in The Journal of the American Medical Association (JAMA) compared survival rates for several different treatment approaches to breast cancer. The primary finding picked up in the press was that the long-term survival rate for women undergoing bilateral mastectomy was not statistically different than that for women who chose lumpectomy and radiation.
I’m not going to outline the entire study – there are a number of good summaries available elsewhere. What particularly caught my interest was the way the study was conducted.
What excited me about the new study is that it is a terrific example of the secondary use of data for informatics-based clinical research. That is, information captured as part of the normal care process for a single patient is combined with information from an entire population segment in order to compare clinical alternatives.Continue reading…
The recent Ebola cases and fatality have triggered a collective process of finger pointing as we struggle to understand events and hold someone accountable.
Hence, the television footage of health officials hauled off to Congress, accusatory headlines (“Alarming stumbles by the C.D.C.”) and appointment of czars. In the desire to pin the blame somewhere, notably the Centers for Disease Control and Prevention (CDC), we overlook the essential fact that in the United States public health responsibilities are fragmented among federal agencies, and decentralized throughout state and local government. The laws and regulations governing public health activities at federal, state and local levels is truly wonky terrain, but understanding these details is critical to being able to improve our response to public health emergencies. We need to know who actually has the authority to deal with specific public health functions and who should be held accountable (spoiler alert – it is not the Czar, nor the Secretary at DHHS, nor the Surgeon General, nor the Director of CDC). Often, it is a state health official, local health official or professional organization.Continue reading…
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.
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.
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.
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.
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.
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.
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.
THCB's Podcasts
Listen to them on Itunes or Spotify
