The Health Care Blog – Page 455 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Ebola, EHRs, and the Blame Game

Oct 23, 2014• 11

By DEBORAH PEEL, MD

It’s time to think carefully and look at the large systems (human and technical), institutions, and individuals that contributed to Mr. Duncan’s death. Systems should be designed to protect people and prevent human errors. Certainly we rely on the healthcare system to improve our health and to protect our privacy, especially our rights to health information privacy.

Looking at the death of Mr. Duncan, the poorly designed Epic EHR was a critical part of the problem: the lack of clarity, poor usability, hard to find critical information, and no meaningful quality testing to ensure the system prevents critical errors contributed to his death and endangered many others. Why wasn’t the discharge of a patient with a temperature of 103 from the ER flagged?

EHRs are one of several critical systemic problems.

Current US EHRs were not designed or tested to ensure patient safety or privacy (patient control over the use of PHI for TPO). The Meaningful Use requirements for EHRs don’t address patient safety or ensure patients’ legal rights to control use of PHI. Let’s face it, the MU requirements were set up by the Health IT industry, not by a federal agency charged with protecting the public, such as NIST or the FDA. Industry lobbying resulted in industry ‘self-regulation’, which has failed to protect the public in every other sector of industry. Industry lobbying is another critical systemic problem.

Our public discourse also is a critical systemic problem. The 24/7 US media drives us to play the ‘blame game’—and look at what happens: it’s a sham. A massive public and social media exercise substitutes for a crucial scientific and ethical oversight process by government and industry to face or examine the systemic causes and key actors—both people and institutions. We end up with no responsibility being assigned or addressed. Or the media hoopla and confused thinking leads to the opposite conclusion: everyone and everything is responsible and blamed, which has the same effect: it lets everyone and everything off the hook. Either way, no one and no institutions are to blame.

Update on CDC Guidelines on Ebola Specimen Handling + Lab Testing

Oct 23, 2014• 1

By THCBist

In response to several reader questions on the CDC post on safe handling of Ebola and recommended lab procedures, the CDC got back to us with this update:

In the Ebola guidance for healthcare workers and specifically for Specimen Handling for Routine Laboratory Testing of persons under investigation (PUI) for Ebola disease , CDC reminds all laboratory personnel to consider all blood and body fluids as potentially infectious. The guidance further informs laboratory personnel that strict adherence to the OSHA bloodborne pathogen regulations and Standard Precautions protects laboratory workers from bloodborne pathogens, including Ebola. In this guidance, emphasis is placed on the OSHA regulation’s requirement for performance of site-specific risk assessments. These assessments should consider the path of the sample throughout the laboratory, including all work processes and procedures, to identify potential exposure risks and to mitigate the risks by implementing engineering controls, administrative controls (including work practices), and appropriate PPE to protect laboratory personnel. Implementation of these recommendations requires that there is designated staff that is trained, competent, and confident in performing risk assessments within their laboratories.

Continue reading…

The Great Checklisting of American Medicine

Oct 22, 2014• 23

By HANS DUVEFELT, MD

Medical errors happen every day. Few make the headlines, but when they do, almost everyone who chimes in to comment offers the same type of solution for avoiding them. Three of the most common are guidelines, decision support and checklists.

From my vantage point as a primary care physician I agree that checklists, in particular, can enhance clinical accuracy, but some of the lists I have to work with in today’s healthcare environment are more likely to bog me down and distract me than focus my attention on the essentials. I call them choke lists.

Re-reading “The Checklist Manifesto” by Atul Gawande, published in 2010, the year before my clinic implemented their first EMR, I am reminded of how much has changed since then.

How I work and where my attention is drawn has changed because of the minutia of Meaningful Use, Patient Centered Medical Home, Accountable Care and all the other new philosophies and forces that define primary health care.

A Virtual Buddy System For Soldiers Returning From War

Oct 22, 2014• 1

By KOGNITO in MARKETPLACE

A new online and mobile app released this week called Together Strong is helping U.S. veterans and service members learn what to say and do when a peer is struggling with post-deployment stress and readjustment to civilian life. Through interactive role-play conversations with 3D and emotionally responsive virtual humans, the user prepares to have real-life conversations that will motivate a friend to access help if needed, build resilience, and lead a healthier life. The app is available for free online and on iOS and Android.

Health Value: IT and the Rise of Consumer Centricity

Oct 21, 2014• 5

CYNDY NAYER

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Accountable care demands that the system sync with the preferences and choices of the consumer purchasing the services. In order to get to real health value, consumer-patients must make the health care decisions that improve personal health and do not derail personal bank accounts. It was hard to piece these together for the last 15 years. Now, with high deductible plans, more transparency for costs, and on-time digital connectivity, there is less difficulty.

Information technology can deliver the needed information to the patient and the physician to improve not only the likelihood of improved care but also the time-to-achieve the outcomes. Most patients want and need to be involved in their care. There is evidence that giving patients access to their information results in higher levels of engagement and adherence to recommendations. In fact, the latest evidence shows that patients have been signing up for access to their health system portals at a rate of 1% per month for over 30 months.

SENSING XCHALLENGE, with Google Hangout Wednesday at 10 PST

Oct 21, 2014• 5

By Matthew Holt

Yesterday XPRIZE announced the 11 finalists for the second phase of the Nokia Sensing XCHALLENGE. This is a $2.25m prize competition to advance the ability to use sensors to measure and manage health, and it’s something that we’re fascinated by at Health 2.0. You may recall that the first round’s winners were unveiled live on stage at the 2013 Health 2.0 Fall Conference by our friends at XPRIZE and Nokia.

UPDATE–The hangout is embedded above. To find out a little more, please come to a Google Hangout at 10 am Pacific/ 1pm EST Wednesday where I’ll be chatting with Dr. Erik Viirre, Medical and Technical Director of the Qualcomm Tricorder XPRIZE and the Nokia Sensing XCHALLENGE; Jonanthan Linkous, Chief Executive Officer of the American Telemedicine Association; Jon Dreyer, President of Health IT Strategic Partners; Dr. Manas Gartia from team MoboSense, a Distinguished Award winner in the Nokia Sensing XCHALLENGE Competition #1; and Dr. Marc Bailey from Nokia Technologies.

You can also see videos of the finalist teams and their breakthrough technologies can be viewed and voted on beginning today through October 30 at http://www.nokiasensingxchallengevoting.org. More on the teams below the fold:

The Antifragile CDC

Oct 20, 2014• 9

By SAURABH JHA, MD

Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested.

I was reading a story about a German tourist (it’s usually a German) who was attacked by a saltwater crocodile in the vicinity (1). The story concluded to reassure that one is more likely to be killed by a vending machine than a saltwater crocodile.

I imagined what the apotheosis of a left brain thinker, the data-driven Renaissance man, might have done with that statistic. Might he have peeked in to the East Alligator River looking for a vending machine and seeing none, jumped right in?

This empirical fact is useful if you suffer from croc-phobia and live in the Upper East Side of Manhattan, and the biggest voyage you ever plan to undertake is to the Hamptons. But it’s not terribly useful, and marginally harmful, if you’re deciding whether to kayak rivers in Northern Australia.

The vending machine has reared its deadly head again. It seems that more Americans have been killed by vending machines than have died from Ebola. Well let’s head to Liberia for the winter, because there are fewer vending machines there.

Sorry, I jest. But this is not a joke. Some actually think this is a relevant statistic to put Ebola in perspective. And some are actually reassured by it!

Connecting, Reflecting and Projecting with American Well CEO Roy Schoenberg

Oct 20, 2014• 1

By MICHELLE RONAN

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In an exclusive interview with Matthew Holt, American Well President and CEO Roy Schoenberg, MD shrugs off the threat of emerging competitors, predicts that United Healthcare will own a telehealth company within the next 12 months, and reveals that his company has “turned the corner” in terms of generating revenue from telehealth services. Schoenberg also shares details of the company’s recently announced integration with Apple HealthKit and the growing use of scheduled telehealth visits to treat chronically ill patients.

Throwing the EHR Under the Bus …

Oct 19, 2014• 59

By JOHN IRVINE

Given what is now known about how the case of Thomas Eric Duncan at Texas Health Presbyterian was handled, the attempt to blame the hospital’s electronic health record for the missed diagnosis sounds pretty lame.

But people are still doing it:

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Critics of electronic medical records have found a case they will be talking about for years.

Consider this argument from Ross Koppel and Suzanne Gordon:

While it is too early to determine what precisely happened in this case, it is not too early to consider the critical issues it highlights. One is our health care system’s reliance on computerized technology that is too often unfriendly to clinicians, especially those who work in stressful situations like a crowded emergency room. Then there are physicians’ long-standing failure to pay attention to nurses’ notes. Finally, there is the fact that hospitals often discourage nurses from assertively challenging physicians.

Long promised as the panacea for patient safety errors, electronic health records, in fact, have fragmented information, too often making critical data difficult to find. Often, doctors or nurses must log out of the system they are on and log into another system just to access data needed to treat their patients (with, of course, additional passwords required). Worse, data is frequently labeled in odd ways. For example, the results of a potassium test might be found under “potassium,” “serum potassium level,” “blood tests” or “lab reports.” Frequently, nurses and doctors will see different screen presentations of similar data, making it difficult to collaborate.

Continue reading…

Data for Health: Coming to a Town Near You …

Oct 16, 2014• 13

By MICHAEL PAINTER, MD

We have some questions for you—questions, that is, about health information. What is it? Can you get it when you need it? What if your community needed important information to make your town or city safe or keep it healthy? How about information about your health care? Can your doctors and nurses get health care information about you or your family members when they need it quickly?

I came across a recent Wall Street Journal article about a remarkable story of health, resilience and survival in the face of an unimaginable health crisis—a Liberian community facing the advancing Ebola infections in their country got health information and used it to protect themselves. When the community first learned of the rapidly advancing Ebola cases coming toward them, the leaders in that Firestone company town in Liberia jumped on the Internet and performed a Google search for “Ebola”.