THCB

Categories

Above the Fold

Engage with Grace at Thanksgiving

Since 2008 THCB has featured Engage with Grace at Thanksgving. We invite everyone to post this to their blog or Facebook page, and to link here with their status update. You can download a “blog ready” html version of this piece in .txt format to drop into your blog software by right-clicking and choosing”save link as” here. This post was written by Alexandra Drane and the Engage With Grace team.

For three years running now bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage with Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

Continue reading…

Could It Be That Patients Aren’t Any Safer?

• 19

By ROBERT WACHTER, MDPicture 16

On the occasion of last year’s tenth anniversary of the IOM Report on medical mistakes, I was asked one question far more than any other: after all this effort, are patients any safer today than they were a decade ago?

Basing my answer more on gestalt than hard data, I gave our patient safety efforts a grade of B-, up a smidge from C+ five years earlier. Some commentators found that far too generous, blasting the safety field for the absence of measurable progress, their arguments bolstered by “data” demonstrating static or even increasing numbers of adverse events. I largely swatted that one away, noting that metrics such as self-reported incidents or patient safety indicators drawn from billing data were deeply flawed. Just look at all the new safety-oriented activity in the average U.S. hospital, I asked. How could we not be making patients safer?

I may have been overly charitable. This week, in an echo of the Harvard Medical Practice Study (the source of the 44,000-98,000 deaths/year from medical mistakes estimate, which launched the safety movement), a different group of Harvard investigators, led by pediatric hospitalist and work-hours guru Chris Landrigan, published a depressing study in the New England Journal of Medicine. The study used the Institute for Healthcare Improvement’s Global Trigger Tool, which looks for signals that an error or adverse event may have occurred, such as the use of an antidote for an overdose of narcotics or blood thinners. Following each trigger, a detailed chart review is performed to confirm the presence of an error, and to assess the degree of patient harm and the level of preventability. While the tool isn’t perfect, prior studies (such as this and this) have shown that it is a reasonably accurate way to search for errors and harm – better than voluntary reports by providers, malpractice cases, or methods that rely on administrative data.

Continue reading…

Thanks Giving

• 3

By ROB LAMBERTSLamberts, MD

Thanksgiving is probably my favorite holiday.  Christmas is great, but the commercialization of it has largely spoiled it.  Thanksgiving seems to be the one holiday that has remained as it was when I was young: a time to be with family and friends, and a time to reflect on the good things in life.

Yet I know for a lot of my patients and readers, finding feelings of thankfulness is difficult or impossible.  I see pain and loss that is hard to understand.  Thanksgiving is looked at my most as a time to thank God for the good in life, but to those who suffer, God seems to have it out for them, or to be ignoring them completely.  To many, Thanksgiving is a sad reminder of happier times.

A boy in my children’s school died suddenly last week of an anemia caused by his body attacking his red blood cells.  It came suddenly, and it happened swiftly.  One day he was a normal 14 year-old kid, and a week later he was dead.

I have friends who are going through divorces, who have lost close family members, or who are dealing with inner demons that make celebration very difficult.

Some patients have physical pain so bad that they can’t even sleep, while others have only a few months to live.

Happy Thanksgiving?

So how do we deal with this reality?  How do we look at the our lives in light of those around us?  Should we feel guilty for our blessings?  Should we ignore those in pain?  Those are hard questions with different answers for different people.  But one thing I do know is that we should not ignore reality.  We can’t pretend life is a sit-com that will work out in the end.  That does an injustice to the pain of those suffering – perhaps more of an injustice than the pain itself.

Here are some of my personal observations regarding these questions.  They are in no way the complete answer (I am sure readers will add their wisdom to this), but it’s helpful for me to put them down.  I hope it helps some of you.

1.  I am most thankful for my giving.  The fact that I have been able to make a mark in people’s lives, to help them in their hard times, to be the person they needed when life was falling apart, is an incredible honor.  Any thing we possess can be taken from us, but what we have done for others is ours forever.  The simple fact that I can help people in their suffering lets me be thankful for what I have.

Continue reading…

The Doctor Will Sync You Now

• 24

By MARKUS POHLApples-app-store-icon-o

Takeaway: mHealth developers expect the importance of app stores to diminish. mHealth apps will predominantly be distributed through traditional healthcare channels by 2015.

Our firm, Berlin-based research2guidance, conducted a global mHealth developer survey in order to identify emerging trends in this new market.

One of the most striking results of the survey was that leading mHealth developers believe that in the years to come mHealth applications will cease to be distributed primarily through the app stores as is currently the case, and that traditional healthcare distribution channels like hospitals and specialized healthcare product vendors will become the predominant distribution channels.

This would represent a significant shift when compared to the market today, as the smartphone app store model has been the key driver behind the initial success of mHealth applications over the last two years.

More than half of all respondents (53%) believe that app stores are currently the best distribution channel followed only by healthcare websites (49%). Traditional health distribution channels like doctors (34%), hospitals (31%) and pharmacies (16%) are ranked as second and third tier distribution channels today. Despite the fact that mobile operators are regarded as players who will help the mHealth market to grow, they are not seen as appropriate distribution channels either now or in the future.

Q: What are the best distribution channels for mhealth solutions today?

Picture 21

Continue reading…

The Penguin Problem

• 11

By VINCE KURAITIS, JD Picture 17

Remember the penguin problem described by economists?

No one moves unless everyone moves, so no one moves.

Overcoming the penguin problem has a lot to do with creating expectations. A recent writing by Dr. James O’Connor in Physician Practice expresses a voice from the physician community that I’ve never heard before.  His essay is entitled “Meaningful Use — Doctors Have No Choice”.

Physicians Have No Choice Other Than to Adopt EHRs?

Dr. O’Connor argues that physicians are effectively being forced into adopting EHRs.  He cites facts and reaches a powerful conclusion:

1. CMS penalties begin in 2015.
2. What if you won’t or don’t accept Medicare/Medicaid patients (13 percent of practices in 2009, up from 6 percent in 2004? In August, four major insurers (Aetna, Highmark, United Health Group, and Wellpoint) announced that, at a minimum, they will link their pay-for-performance programs to federal meaningful use criteria. Other insurers are likely to follow.
3. Do you run one of the increasing number of “boutique” or VIP practices that work on a cash-only basis? The American Board of Medical Specialties (ABMS) released a statement in August saying that they intend to link meaningful use of health information technology into the ABMS Maintenance of Certification© program.
4. You don’t care about being board certified? (Sound of crickets chirping.) The Final Rule gives states the authority to impose additional requirements that promote compliance with meaningful use. As reported in Physicians Practice, the state of Massachusetts may take away your license to practice medicine in 2015 unless you demonstrate meaningful use of an EHR system. In Maryland, private insurers will be required to build incentives for acquisition of EHRs and penalties for not adopting them into their payment structure.

OK, so technically, we do have a choice. We could stop taking Medicare and Medicaid patients, accept cash only, give up our board certification (and thus usually hospital privileges), and move to a state (or country) that doesn’t impose EHR requirements. But is that really a choice? No.

Continue reading…

assetto corsa mods