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Making it count

I’m back from the very content-heavy MedInfo conference and trying to dig through all the info I collected in San Francisco.

As of today, I am able to track traffic on this page. What took me so long? (Thanks to Dr. Chuck Webster of JMJ Technologies for pointing me in the right direction.)

To other bloggers, news services and news makers: Let me know if you want to trade links. My e-mail is nversel@rcn.com.

September 13, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Another viewpoint: Cedars may be doomed to fail again

SAN FRANCISCO—After reporting in Thursday’s Health-IT World News that Cedars-Sinai Medical Center in Los Angeles had made changes in the workflow of its cath lab in the wake of the January 2003 demise of its computerized physician order entry system, I received an e-mail from a physician who says that Cedars has not fixed the fundamental problems that led to the failure.



With the permission of the writer, here goes.

While it is a good thing that Cedars-Sinai is trying to “learn from its CPOE mistakes to improve workflow,” I suggest that the likelihood of failing again may be too high for comfort for two major reasons.

I am uncomfortable that they may assume that a “failure analysis” need not include a comprehensive review of organizational and sociological issues leading to failure. Internal “politics”, territoriality, suitability of the intellectual capital in the hospital I.S. departments towards implementing systems that impinge on clinical practice directly, IT project leadership models, and related issues, are in my opinion of much greater importance than “work flow process analysis” in assuring success. The circumstances of the first failure suggest that these issues are not being managed well.

For more on these matters, see the introductory section of my web page “Common examples of healthcare IT failure” at http://members.aol.com/medinformaticsmd/failurecases.htm. I authored and edited this material via an internet collaboration with other Medical Informaticists several years ago. This intro was recently published in your competitor’s journal, Health IT Strategist, in August.

The other major reason the second CPOE effort might fail is due to the assumption that “work flow process analysis” is the correct process for a busy clinical environment. A paper written by one of the students here addressed this issue by citing a 1998 article, “Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context,” (Berg M. et al, International Journal of Medical Informatics, 1998;52:243-251) as follows:

“… Social studies of professional work have show repeatedly that professional knowledge and information cannot be conceptualized as atomic bits and pieces that can be stored and retrieved at will, and that can be unequivocally mapped on simple, universal schemata.”

Professional knowledge is a complicated thing and must be dealt with case by case, it is never the same. The depictions of the formal workflow of medical work are often not realistic, for example the task boundaries between doctors and nurses are not always tightly drawn.

Translating professional knowledge and work flow processes into some automated record is not impossible but much care and evaluation must be taken for it to not be hazardous to a healthcare environment.

Medicine is complex. Good relationships between the stakeholders (the executives, clinicians, and IT personnel) are the biggest key to success.

While I wish Cedars-Sinai the best of luck on attempt two, I am not optimistic, based upon the learnings you describe from attempt one.

Scot M. Silverstein, MD

Adjunct faculty

Drexel University

College of Information Science & Technology

Institute for Healthcare Informatics

Philadelphia

Former director of scientific information resources at Merck & Co. Inc.

E-mail: sms88@drexel.edu

September 10, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Whither Medicaid?

SAN FRANCISCO—Since Medicare can’t really change its payment mechanisms without an act of Congress and private health insurers generally don’t change until Medicare does, why hasn’t a state Medicaid program stepped up to the plate by offering incentives for health providers to install clinical information technology?

With Medicaid, there is more leeway to make significant changes because states set many of their own rules.

I asked this question of Dr. Bill Yasnoff, National Health Information Infrastructure coordinator at HHS. He was here for the international MedInfo conference this week.

“I’m baffled that the governor’s association doesn’t go to HHS with this,” Yasnoff said.

I can personally assure you that there will be more reporting on this topic. In the meantime, while I’m still here in California, I’d like to know why Gov. Arnold Schwarzenegger and his counterparts across America are being such Medicaid girlie men.

September 9, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

It’s not IT, but it’s significant savings for the healthcare system

Normally I try to limit my comments to ways in which information technology is aiding patient safety and healthcare quality, but something more medical caught my eye this morning:

Since the the Centers for Disease Control and Prevention recommended the varicella vaccination for all U.S. children in 1995, the rate of hospitalization for chicken pox fell by three-fourths, according to a study in the September issue of Pediatrics.

The researchers, from the University of Michigan, further found that charges for chicken pox-related hospitalizations declined from $161.5 million in 1993 to $66.3 million in 2001. That 59% decrease represents $95.8 million in spending removed from the U.S. healthcare system in an eight-year period.

I am off to San Francisco this evening for the triennial, international MedInfo conference. Watch this space for news and updates.

September 7, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Some real progress

A while back I wondered aloud if and when the Continuity of Care Record might start showing up in the real world.

It already has, in a few limited instances.

The Nebraska Medical Center, part of the University of Nebraska Medical Center in Omaha, recently started crowing about the fact that that its cardiology and internal medicine departments offer patients free copies of their own medical records on CD.

Let’s hope patients start taking advantage of the offer—and taking their records with them when they visit other care providers or travel out of town.

(Thanks to iHealthBeat and the Associated Press for tipping me off to that one.)

Meanwhile, Methodist Medical Center of Illinois, in Peoria, Ill., says that it has reduced medication administration errors by more than half since adopting barcode technology in the pharmacy and at the bedside three years ago, according to a Health-IT World News report this week.

In Tulsa, Okla., the five-month-old St. Francis Heart Hospital is wrapping up the installation of its wall-to-wall clinical IT systems for the “all digital” facility. The hospital will announce some early results and observations at a Sept. 13 press conference. St. Francis will be at least the second fully digital heart hospital wired by GE Healthcare, following last year’s opening of the Indiana Heart Hospital in Indianapolis.

Looking forward, next week is the MedInfo conference in San Francisco, the triennial meeting of the International Medical Informatics Association. This conference has not been in the United States since 1986.

I will be there to file reports for several news outlets and will post some observations here.

And speaking of conferences, HIMSS is planning a demonstration of online personal “virtual” health records and cross-enterprise interoperability at its 2005 show in Dallas next February. Read the press release for more details.

Vendors and other organizations wishing to participate have until Oct. 15 to register.

September 2, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.