The Health Care Blog – Page 933 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Checklists (The Sequel)

Feb 15, 2009• 3

By Bob Wachter

Last month’s New England Journal included another astounding checklist study,
an international extravaganza that found nearly 50% reductions in
mortality and complications after implementation of pre- and post-op
surgical safety checklists.

Wow.

Coincidentally, I read the study, conducted by a research team led by surgeon/author extraordinaire Atul Gawande,
on my way home from a meeting at the headquarters of the Agency for
Healthcare Research and Quality (AHRQ). The AHRQ gathering brought
together the advisors to a new rollout of the Hopkins/Michigan
checklist program to prevent central line-associated bloodstream
infections (CABSI) to 10 additional states. You remember that study, published in the NEJM in 2007: implementation of a simple 5-item checklist in more than 100 Michigan ICUs led to over 1000 lives saved.

Commentology

Feb 15, 2009• 1

MToubbeh, MD wrote us in response to Eric Novack's slightly incendiary post. ("The Expansion of the Federal Healthcare Bureaucracy Bill")

I don't think that when we built the Highway system
in the country that people were worried that the Government was going
to control the flow of travel. The ONC was established under the Bush administration, is headed up by
a provider and the new advisory board (NeHC) has at least 8 physicians
on it including many who post on this blog regularly.

This
bill in fact has blocked the power of many lobbying groups (ie it isn't
a vendor dominated organization) and is only one small part of the
total amount of money that needs to be implemented in health IT. The
private sector has been catering to their clients (hospitals) and both
providers and consumers have been left out of this process up until
now.

Bev MD had this comment on David Kibbe's landmark post on Clinical Groupware:

"As
a former medical laboratory and blood bank director, I have seen every
conceivable(and some inconceivable) way that a patient's identity can
be mistaken and incorrect information entered in a patient record. This
is one reason why every blood bank will re-draw a patient's blood on
every admission to confirm their blood type is really the same as what
is in their record. And no, one cannot rely on the patient himself to
verify the information, for a variety of reasons. Please do not
overlook the critical necessity for at least one, preferably two,
unique patient identifiers in any type of system that is developed – or
you may literally kill someone."

The Japanese Dr. Koop

Feb 13, 2009• 3

By John Halamka

As readers of my blog know, I'm a great fan of the Japanese culture,
lifestyle, and people. I'm on a speaking tour of the country this week,
meeting with government, academia, and industry leaders in
Tokyo,
Nagoya and Kyoto. Every time I visit Japan I learn more about the
language, the arts, and tradition. The trip thus far has been
remarkable with many insights into the challenges of their healthcare
system, their plans for EHRs and their emerging interest in PHRs. I've
met many friends and colleagues, had great vegetarian meals, and
mastered the Tokyo subway system.

One of the most interesting
experiences was having lunch with Dr. Shigeaki Hinohara, the most
famous physician in Japan. He's 97 years old and loved by everyone –
the Japanese version of Dr. Koop. He has published over 150 books since
his 75th birthday, including one "Living Long, Living Good" that has
sold more than 1.2 million copies. As the founder of the New Elderly
Movement, Hinohara encourages others to live a long and happy life, a
quest in which no role model is better than the doctor himself.

The Stimulus Pregame

Feb 13, 2009• 18

By ROBERT LASZEWSKI

"Drug Makers Fight Stimulus Provision"

"Lobbying War Ensues Over Digital Data"

The first was a recent and the second headline comes from the Washington Post. Both refer to what were supposed to be two already agreed on health
care reform ideas–comparative research about which treatments work
best and the creation of a nationwide system of medical records.

The lesson here is that in health care nothing is easy, simple, or widely agreed to.

Why Clinical Groupware May Be the Next Big Thing in Health IT

Feb 13, 2009• 46

By David C. Kibbe

What would you call health care software that:

Is Web-based and networkable, therefore highly scalable and inexpensive to purchase and use;
Provides a ‘unified view’ of a patient from multiple sources of data and information;
Is designed to be used interactively – by providers and patients alike – to coordinate care and create continuity;
Offers evidence-based guidance and coaching, personalized by access to a person’s health data as it changes;
Collects, for analysis and reporting, quality and performance measures as the routine by-product of its normal daily use;
Aims to provide patients and their providers with a collaborative workflow platform for decision support; and
Creates a care plan for each individual and then monitors the progress of each patient and provider in meeting the goals of that plan?

I call this Clinical Groupware. The term captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.

The Expansion of the Federal Health Care Bureaucracy Bill

Feb 13, 2009• 8

By ERIC NOVACK

With the conference report available on the web, here are the references to the health care provisions in the conference report of the 'stimulus' bill. I have not gone into great detail on the privacy provisions (which are, in large part, dedicated to a new aggressive federal watchdog/ punishment regime to enforce the privacy standards– that have not been developed yet).

Nor have I done a complete look at the COBRA and Medicaid expansion provisions.

But, make no mistake, this may be called a 'stimulus' bill— but it is really a massive expansion of the federal health care bureaucracy.

A Consumer Advocate’s Take On the Economic Stimulus and HIT

Feb 13, 2009• 2

By Eva Powell

In light of all the discussion about the Economic Recovery Plan and
the privacy provisions in the HIT Title, I thought it might be helpful
to provide a consumer advocate’s view. The National Partnership for
Women & Families leads a coalition of consumer, patient, and labor
groups, the Consumer Partnership for eHealth (CPeH). The organizations
in this coalition are working to advance HIT adoption, because we know
that achieving better coordinated, higher quality health care demands
the integration of new technologies into the health care delivery
system.

Frances Dare, Cisco’s optimist, and KP’s Garfield Center

Feb 13, 2009

By Matthew Holt

From time to time we check in with my pal Frances Dare who is Cisco’s optimist about the impact that IT will have on health care (FD I’ve worked for Cisco in the past). Here’s an interview I did with her on HC IT policy last year.

Her handlers sent me this piece of video where she was interviewed about the role Cisco’s version of connected health could play in improving hospital efficiency. (Warning—you need to log in and give Cisco your email to see the video and once you get there I recommend skipping the first 3 minutes of corporate-marketing speak and wind straight onto Frances)

Meanwhile, I went on a tour last week of the Kaiser Garfield Center (which was very cool even though I haven't gotten around to writing about it yet!) and on it I was reminded about the role connectivity has to play in hospital design. As well as reaching out to the home.

Commentology

Feb 12, 2009• 1

Jay wrote in on Dr. John Haughton's post on the health IT provisions in the latest version of the stimulus package. ("Stimulus bill offers docs big incentives for technology, but demands effective use.")

"While a move to EMR is a necessity to reduce medical costs for the
country, I don't believe that providing purely financial incentives for
individual doctors is going to bring about the desired change. So many
doctors are already operating as small business owners so going through
the selection, procurement, integration and ongoing maintenance of an
EMR system is going to be both time consuming and expensive, much more
so than the $40K in incentives.

How many doctors are going to be a position to effectively wade
through the sea of EMR systems to find one that will integrate as
painlessly as possible with their clinical activities. By my judgment,
not that many. At the same time, what happens when a particular system
fails to meet expectations or fails outright; is the doctor paying
someone to be on the phone to work through the technical issues? How
much support is the doctor going to receive as just one small user of a
product?

In my mind, a far better solution and use of the funds would be for
a centralized application commissioned by the federal government."

Stuart wrote in on the same thread, with an alternative suggestion:

Omitted in the "stimulus" bills is EHR using very secure, patient-carried EHR smart cards. They are well-proven, safe, easy to use, effective and in wide use in the EU. The French card system gets especially high marks.
But why ask our EU friends for a proven system when we can waste $20B screwing around for years with web-based systems that are so insecure that Americans will never agree to their use?

10 Simple Rules For a Non-adversarial Healthcare System

Feb 12, 2009• 5

By Peter Nesbitt

Most discussions regarding health care focus on parts that need fixing. Health care has many parts and some are broken and some aren't. But if we want to solve the problem, first we better decide on whether we have the right model. In the model that follows, we strongly emphasize building trust between participants but, as always, trust has to be verified.

Several years ago, we had the idea of building a non-adversarial managed care system for large employers and their injured workers. We named it "The Managed Care Alliance." As people familiar with workers' compensation know, it is among the most adversarial medical systems in the world. Employers and payers have little control over medical care and attendant costs. Abuse was rampant and providers, patients, and payers were pitted against each other. Many cases ended up in the courts. Our theory was that by eliminating friction, we could better ensure appropriate care for patients and significantly lower costs. Over a 10 year period during which I was involved, that is exactly what happened.