The Health Care Blog – Page 986 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Should a surgeon be punished for wrong-site surgery?

Jul 20, 2008• 6

By Paul Levy Surgeon

During these couple of weeks following our wrong-side surgery, a number of people
have asked me if we intend to punish the surgeon in charge of the case, as well as other people in the operating room, who did not carry out the expected time-out procedure.

My initial and immediate reaction has always been, "No, these people have been punished enough by the searing experience of the event. They were devastated by their error and distraught to think that they could have participated in an event that unnecessarily hurt a patient. The surgeon immediately reported the error to his Chief and to me and took all appropriate actions to disclose and apologize to the patient, as well as participate openly and honestly in the case review."

This reaction was supported by one of our trustees, who likewise responded, "God has already taken care of the punishment." But another trustee said that it just didn’t feel right that this highly trained physician, "who should have known better," would not be punished. "Wouldn’t someone in another field be disciplined for an equivalent error?" this trustee asked.

Birthing turf wars

Jul 18, 2008• 7

By Vijay Goel

This spring, the American Medical Association decided to support a legislation "that
helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.

So the AMA is against ANY women choosing to give birth at home. This appears to be based more on turf management than evidence.

(The issue erupted following the release of the documentary, "The Business of Being Born," by former talk show host Ricki Lake in which she haves her baby at home. The American College of Obstetricians and Gynecologists and AMA publicly criticized Lake, who wrote about the ordeal last month for the Huffington Post.)

Governors saddled with health costs

Jul 18, 2008• 7

By Jane Sarasohn-Kahn

The National Governors Association (NGA) met in Philadelphia this week, where my City of Brotherly and Sisterly Love is witnessing some sobering discussions about health care.

On the one hand, Bill Clinton called in his opening keynote speech for the states to be laboratories of democracy.

But how much health-democracy can each governor afford when balancing their budget in the face of declining revenues? According to the NGA’s 2008 Fiscal Survey of the States, not a whole lot.

Investigative journalism is good for the nation’s health

Jul 18, 2008

By Sarah Arnquist

Despite seemingly never-ending reports of layoffs in American newsrooms, a new model of investigative journalism has emerged and health care falls squarely into its areas worthy of significant scrutiny. Propublica

ProPublica is a nonprofit, investigative journalism organization that launched this year with promises to focus its efforts on "truly important stories, stories with moral force." Its Web site is up and filled with great content, including a section on health and science.

The founders/funders of ProPublica — led by the Sandler Foundation — believe "investigative journalism is at risk," and are pioneering this new model. Paul Steiger, a former managing editor of The Wall Street Journal, is at the helm.

What does this have to do with health care? ProPublica has targeted health care as an area worthy of investigation. That’s evident by the recent recruitment announcement of Charles Ornstein and Tracy Weber from the L.A. Times.

AHIP starts smoking astroturf

Jul 17, 2008• 8

By Matthew Holt

Let’s say you ran a lobbying organization that may (or may not) be staring into a political storm. And say that you’d just lost a battle with opponents within the health care industry that you thought you’d won in 2003.

Now, say you “believe” that the 47 million people — who are uninsured in part (but to be fair, only in part) due to your members’ greed, political choices and incompetence over the years — represent a market for your members.

Say your organization had some members who could possibly adapt to a new world, where tightly regulated organizations were contracted under strict terms to provide care to the whole population in a social insurance scheme — with appropriate risk-adjustment and other mechanisms in place to promote the care management you say your members do so well.

And say then it had other members, who are mere sharks and who would go out of business the minute they were banned from cherry-picking only the best customers and selling them quasi-fraudulent products.

Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?

Jul 17, 2008• 27

By Brian Klepper

Those who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few realities.First, think about the fact that when the Democrats retook Congress, they tweaked but did not fundamentally change the lobbying rules that trade money for influence over policy. In fact, most contributors have now adjusted their contributions to favor the current, rather than the past, majority party. As it turns out, Democrats, like Republicans, are only too eager to allow special interests to trump the common interest, so long as the transactions fetch a good price.

Commonwealth puts the boot in, again

Jul 17, 2008• 8

By Matthew Holt

Veteran THCB readers shouldn’t need too much reminding about this, so I’ll spare you the blow by blow documented here over the years. Here’s the bottom line. Any time you do a trans-national study on health care, you find that the U.S. spends way too much and gets way too little in terms of quality and outcomes.

In doing these studies the Commonwealth Fund has become the bete noir of the political right.

Why? Well it starts with data first and then draws conclusions, rather than the opposite approach followed by most on the right. And whatever way you look at the data they’ve produced over the years, it’s clear that things aren’t going well.

Hospital rankings for positive press or for real?

Jul 17, 2008• 2

By Sarah Arnquist Wirehospitals

Hospital & Health Networks magazine announced America’s "100 Most Wired" hospitals for 2008 this week.

You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report.

Hospital & Health Networks created the "most wired" ranking a decade ago. This issue’s cover story says that wired hospitals have happier patients and higher quality measures than their less technologically advanced peers.

"Taken together, the patient satisfaction and quality indicator analyses
provide the strongest evidence in the 10-year history of the Most Wired
Survey and Benchmarking Study that information technology makes a
difference in both the patient experience and the quality of care."

Mr. HISTalk has a more cynical take on the ranking.

Interview with Trizetto & Eliza

Jul 16, 2008

By Matthew Holt

Due to poor planning on my part, this morning I was up scandalously early to talk with Gene Drabinksi, who runs the CareAdvance unit of Trizetto, and Alexandra Drane, President of Eliza.

Last week they announced a partnership that integrates the care management aspects of Trizetto’s services with the automated phone outreach provided by Eliza. It’s another step in the evolution of phone-based contact and personalization in health care — which, the careful THCB reader will have noted, I think is an important channel for delivering and capturing health information.

Of particular importance, is making useful that vast glob of data stored within a health plan by communicating about it with the members. It’s also always good to hear from some experienced and passionate players, and Alex and Gene certainly fit that bill. As I hadn’t had any coffee, I wouldn’t claim the same for myself!

Here’s the interview.

Health IT supporting our troops

Jul 16, 2008

By John Halamka Coin

I spent yesterday in Washington with Major General Elder Granger, Deputy Director in the Office of the Assistant Secretary of Defense for Health Affairs.

We discussed electronic health records, personal health records, decision support, and interoperability. Here’s a brief overview of the electronic systems supporting our troops. Go here for additional details.

AHLTA-T is a PDA version of the Department of Defense Health Record running on Windows CE devices. The DOD tests all of its battlefield technology at Fort Detrick for ruggedness in battlefield conditions — heat, sand, ice, water, and physical abuse. A shock resistant enclosure keeps the PDAs safe. The AHLTA-T record itself has an iPhone-like interface with radio buttons and touchable graphics to rapidly record a battlefield assessment. It generates a structured history and physical, then creates a care plan based on triage rules and best practice protocols. The user interface is designed to be easy to navigate in high stress conditions. Given the lack of WiFi and reliable cellular in battlefield conditions, cradle sync is used to transfer all the medical records to AHLTA system.

Once in AHLTA, battlefield data joins the patient’s lifetime health record and is available worldwide for clinical care. Patients may be evacuated to Germany and upon arrival, their entire updated record is available to the care team.

AHLTA data is transferred to a Clinical Data Repository where it is available for institutional review board approved clinical research, surveillance, and quality reporting. DOD leadership has real-time dashboards showing injury, biosurveillance, and medical supply data.

The DOD also has an integrated pharmaceutical repository with over 1 billion records from pharmacies and pharmacy benefit managers which dispense medications to the armed forces and their families.

When a patient leaves the armed forces and becomes a Veteran, their lifetime medical record is available in the Veteran’s Administration VISTA system via the Bidirectional Health Information Exchange (BHIE) built to connect the DOD and VA systems.

It’s an impressive system, incorporating national standards, serving our troops throughout their lifetime.

As I left, General Granger shook my hand and passed along his personal coin (photo above), just as Dr. Koop had done with me a few months ago.

I look forward to a productive collaboration between the DOD and the non-profit health care world I live in everyday. I’m confident there are decision support alerts/reminders, mobile device implementations, and data exchange experiences that we’ll be able to share for our mutual benefit.