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Patient safety update

I’m passionate about patient safety. I’m happy to report a couple of things that aren’t exactly breaking news, but still worth bringing to your attention.

First off, there is a fairly new peer-reviewed journal called Diagnosis, and it’s about exactly what the title suggests. The first, quarterly issue, from German academic publisher De Gruyter (North American headquarters are in Boston), came out in January, so the second issue should be published soon. The online version is open access. That means it’s free. (A print subscription is $645 a year.)

A highlight of the premiere issue is a submission from the legendary Dr. Larry Weed and his son, Lincoln Weed, discussing diagnostic failure and how to prevent it. “Diagnostic failure is not a mystery. Its root cause is misplaced dependence on the clinical judgments of expert physicians,” they begin. The answer? Clearly defined standards of care and wider use of clinical decision support tools. It’s not anything new. Larry Weed has been advocating this for a good 50 years and saying that the unaided human mind is fallible for probably 60 years. Yet, medicine still largely relies on physicians’ memory, experience and recall ability at the point of care.

This doesn’t mean evidence-based medicine ,which is based on probabilities. Probabilities are fine when the patient has a common condition. They’re useless for outliers. No, Weed has long said that IT systems should help with diagnosis by “coupling” knowledge to the patient’s particular problem, and this starts with taking a complete history.

Weed, of course, created the SOAP (subjective, objective, assessment, plan). I recently talked to a CMIO who is advocating flipping that around a bit  into an “APSO” (assessment, plan, subjective, objective), which he said works better with electronic records. I’ll have more on that in an upcoming article for a paying client, and I’ll probably want to dive into that again in the near future.

For those who still believe American healthcare is safe, effective and efficient, ProPublica worked with PBS Frontline and marketing firm Ocupop last year to produce a video “slideshow” called “Hazardous Hospitals.” It’s worth a view for healthcare industry insiders, and definitely merits sharing with laypeople. I recommend that you share it. Please. Do it. Now. I’m serious. Patient safety is a problem that doesn’t get enough attention. :)

 

March 25, 2014 I Written By

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

All my HIMSS coverage in one place

The last of my 10 MedCity News stories from HIMSS14 has been posted. It’s a nice mix of news, features, analysis and commentary. Here are links to all of them, in chronological order.
NantHealth launches Clinical Operating System – biggest of big data startups – with $1B (Feb. 25)

Body + biology + behavior: Intel exec explains how technology is making N=1 care possible (Feb. 26)

Tavenner: 2014 is your last chance for a hardship exemption for Meaningful Use 2 (Feb. 27)

HIMSS crowd skeptical of promise for flexibility on MU2 hardship requests (Feb. 27)

Google Glass startup expecting third healthcare client in less than 6 months (Feb. 27)

DeSalvo: True EHR interoperability – and a national HIE – is possible by 2017 (Feb. 28)

DeSalvo meets and greets – briefly – while Tavenner keeps her distance at HIMSS (March 3)

HIMSS Intelligent Hospital tracks patients, pills and clinicians in completely connected loop (March 5)

Interoperability Showcase uses car crash to show how connected data really can improve patient care (March 5)

Athenahealth’s first inpatient product isn’t quite an EHR, but a ‘Trojan horse’ into hospitals (March 10)

 

March 12, 2014 I Written By

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

‘Escape Fire’ leaves out IT, ultimately disappoints

I finally got the opportunity to catch the documentary film “Escape Fire,” a good 15 months after it went into limited theatrical release and became available in digital formats. I thought it would be an eye-opening exposé of all that ills the American healthcare industry, particularly for those who somehow believe we have the greatest care in the world. I excitingly ran this graphic when I first mentioned the movie on this blog back in October 2012:

The well-paced, 99-minute film interviews some notable figures in the fight to improve American healthcare — safety guru and former CMS head Dr. Don Berwick, journalist Shannon Brownlee, integrative medicine advocates Dr. Andrew Weill and Dr. Dean Ornish — as well as some lesser-known people trying to make a difference. It goes through a laundry list of all the culprits in the overpriced, underperforming mess of a healthcare system we have now, and examines approaches that seem to be producing better care for lower cost.

I expected the movie to have a liberal slant, but it really stayed away from the political battles that have poisoned healthcare “reform” the last couple of years. About the only presence of specific politicians were clips of both President Obama and Senate Republican leader Mitch McConnell both praising a highly incentivized employee wellness program at grocery chain Safeway that reportedly kept the company’s health expenses flat from 2005 through 2009, a remarkable achievement in an era of escalating costs.

However, filmmakers Matthew Heineman and Susan Froemke did discuss all the lobbyists’ money presumably buying off enough votes in Washington and at the state level that has helped entrench the status quo. They even scored an interview with Wendell Potter, the former top media spokesman for Cigna, who became a public voice against abuses by health insurers because his conscience got the better of him. As Brownlee noted in the film’s opening, the industry “doesn’t want to stop making money.”

Other reasons given for why healthcare is so expensive, ineffective and, yes, dangerous include:

  • direct-to-consumer drug advertising leading to overmedication;
  • public companies needing to keep profits up;
  • fee-for-service reimbursement;
  • the uninsured using emergency departments as their safety net;
  • lack of preventive care and education about lifestyle changes;
  • a shortage of primary care physicians;
  • cheap junk food that encourages people to eat poorly; and
  • severe suffering among the wounded military ranks.

The filmmakers also kind of imply that there isn’t much in the way of disease management or continuity of care. Brownlee described a “disease care” system that doesn’t want people to die, nor does it want them to get well. It just wants people getting ongoing treatment for the same chronic conditions.

One physician depicted in the movie, Dr. Erin Martin, left a safety-net clinic in The Dalles, Ore., because the work had become “demoralizing.” The same people kept coming back over and over, but few got better because Martin had to rush them out the door without consulting on lifestyle choices, since she was so overscheduled. “I’m not interested in getting my productivity up,” an exasperated Martin said. “I’m interested in helping patients.”

Another patient in rural Ohio had received at least seven stents and had cardiac catheterization more than two dozen times, but never saw any improvement in her symptoms for heart disease or diabetes until she went to the Cleveland Clinic, where physicians are all on salary and the incentives are more aligned than they were in her home town. As Berwick importantly noted, “We create a public expectation that more is better.” In this patient’s case, she was over-catheterized and over-stented to address an acute condition, but not treated for the underlying chronic problems.

The film also examined how the U.S. military turned to acupuncture as an alternative to narcotics because so many wounded soldiers have become hooked on pain pills. One soldier, a self-described “hillbilly” from Louisiana, got off the dozens of meds he had become addicted to and took up yoga, meditation and acupuncture to recover from an explosion in Afghanistan that left him partially paralyzed and with a bad case of post-traumatic stress disorder. The only laugh I had in the movie was when he told the acupuncturist at Walter Reed Army Medical Center in Washington, “Let’s open up some chi.”

I kept waiting and waiting for some evidence of information technology making healthcare better, but I never got it. After leaving the Oregon clinic, Martin took a job at a small practice in Washington state where she was seen toting a laptop between exam rooms, but, for the most part, I saw paper charts, paper medication lists and verbal communication between clinicians.

What really bothered me, however, is the fact that there was no discussion of EHRs, health information exchange or clinical decision support, no mention of the problem of misdiagnosis, no explicit discussion of patient handoffs, continuity of care, medication reconciliation and so many other points where the system breaks down. You can’t truly fix healthcare until you address those areas.

 

January 21, 2014 I Written By

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

Say it with me: clinical decision support

I just read one of the worst articles I’ve ever seen about the quality of American healthcare, and it illustrates just how badly some reporters who don’t regularly cover healthcare can misunderstand this sector that accounts for more than one-sixth of the U.S. economy.

I give you this Motley Fool story entitled, “The 5 Most Misdiagnosed Diseases,” written by Sean Williams. (His profile says he has experience investing in healthcare. Investing in companies is one thing. Figuring out how to fix a broken industry is another. And really, from a financial standpoint, plenty of people are getting rich off of others’ suffering.)

The story curiously discusses a 2009 study in the Internet Journal of Family Practice that found the five most misdiagnosed diseases, based on autopsy and malpractice data. I suppose Motley Fool might decide to run something that’s four years old in order to discuss current investment opportunities. This is where the story veers off the rails.

According to the article: “The benefit of this data is twofold: it exposes problem areas in diagnosing certain diseases, which should help improve attention to detail from both physicians and patients exhibiting those symptoms, and it highlights the potential for more accurate diagnostic equipment. As investors, it also gives us definable opportunities to take advantage of instances where certain medicines or diagnostics may greatly increase in usage to improve patients’ quality of life.”

Wrong.

The problem isn’t the accuracy of diagnostic equipment and the solution isn’t more expensive testing and treatment. The problem is accessing and processing data that physicians should already have but perhaps do not. The answer to this problem is an accurate, current and complete record with an accurate, current and complete patient history, run not through the physician’s brain on the spot but through a clinical decision support engine that matches patient-specific facts with known medical evidence.

Say it with me: clinical decision support.

 

July 21, 2013 I Written By

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

Video: Live from HIMSS with Athenahealth CEO Jonathan Bush

NEW ORLEANS—I made my debut for the new Health Innovation Broadcast Consortium last night with a live webcast interview with Athenahealth CEO Jonathan Bush. As usual, I didn’t need to prepare much for the interview because Bush almost interviews himself, so I just decided to wing it. Also as usual, we kept it light, as each of us had a beer in our hand, since we were at the House of Blues in the French Quarter, where Athenahealth had its annual HIMSS party. (This year featured a jazz funeral marking the “death of software.”) But we did discuss some topics actually relevant to health IT, including meaningful use and Athenahealth’s recent acquisition of Epocrates. Enjoy.

Watch live streaming video from hibc at livestream.com
March 4, 2013 I Written By

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

Video: Dell Healthcare Think Tank at HIMSS12

The video from the Dell Healthcare Think Tank dinner at HIMSS12 last week, which I participated in, is now available. It’s long, but if you’re into health IT policy and healthcare reform, it probably is worth your time.

February 26, 2012 I Written By

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

Podcast: UPMC informatics leader Shrestha talks accountable care, business intelligence

Did you happen to catch my InformationWeek Healthcare story about how UPMC believes it has the roadmap in place to achieve true accountable care? Well, here’s the rest of the story.

Last week, Nuance Communications invited me to Pittsburgh for a tour of the Center for Connected Medicine, an impressive, high-tech showcase on the 60th floor of the U.S. Steel Tower. There, I interviewed, among others, Rasu Shrestha, M.D., UPMC’s vice president for medical information technology, medical director of interoperability & imaging informatics and division chief of radiology informatics. Here is that interview.

Podcast details: Interview with Rasu Shrestha, M.D., UPMC vice president for medical information technology, Feb. 7, 2012, at the Center for Connected Medicine, Pittsburgh. MP3, stereo, 128 kbps, 15.6 MB, running time 17:08.

1:10 “Clinical language understanding” and “bringing data to life”
3:05 Analytics beyond patient care
3:55 Computer-assisted coding
6:35 Business intelligence in the context of ACOs
7:45 UPMC striving to be an ACO
8:35 Aggregating data from payer and provider sides of the organization
10:30 Keeping medication lists up to date
11:45 Health information exchange among multiple vendor systems
13:00 What to watch for in the near future from UPMC
14:10 Overcoming cultural barriers to change

 

 

 

February 14, 2012 I Written By

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

Podcast: IBM Distinguished Engineer Scott Schumacher envisions the ‘clinical hub’

In part two of my series from month’s IBM Exchange 2011, my guest is IBM Distinguished Engineer Scott Schumacher. In this lively podcast, Schumacher discusses Watson, disease management and the concept of the “clinical hub,” which envisions bringing together clinical decision support and case management.

As with my previous podcast with IBM’s Lorraine Fernandes, I set my mic too low. I boosted the level during editing, but that introduced more background noise than I’d like. Schumacher mostly comes through nice and clear, though.

Podcast details: Interview with IBM Distinguished Engineer Scott Schumacher, recorded Sept. 14, 2011, in Chicago. MP3, stereo, 128 kbps, 13.2 MB. Running time 14:25.

0:30 What the IBM Exchange is
1:38 The “clinical hub”
2:30 Population analytics and individual patient analysis
4:20 Applying Watson intelligence and other medical knowledge
5:40 Target customers for clinical hub
7:10 Technical challenges
8:15 Potential for the technology
9:00 Video/image mining
10:00 Plans for testing and deployment
11:35 Mining of clinical notes and patient history
12:30 Incorporation of genomics and predictive treatment plans

October 23, 2011 I Written By

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

Announcing Health eVillages

I’m involved in this project that’s being announced right now. I’ll have my perspective in MobiHealthNews.

Physicians Interactive and the Robert F. Kennedy Center for Justice and Human Rights Launch Health eVillages mHealth Initiative

First-Ever Consortium of Healthcare and Human Rights Organizations Providing Mobile Medical Technology to Challenged Regions Worldwide

MARLBOROUGH, MA, Sep 26, 2011 (MARKETWIRE via COMTEX) — Today marks the official launch of a historic healthcare and human rights advocacy consortium, Health eVillages, which aims to bring mobile medical reference and decision support technology to clinicians fighting to save lives in underserved regions worldwide. Physician’s Interactive Holdings, with its subsidiary Skyscape.com, Inc., in partnership with the Robert F. Kennedy Center for Justice and Human Rights, will formally announce the creation of Health eVillages during this year’s Health 2.0 Conference. Health eVillages will be assisting healthcare professionals practicing medicine in the most challenged clinical environments, by providing them with mobile clinical reference and decision support tools for medical training, diagnostics and clinical references.

“Putting these devices in the hands of healthcare professionals who require access to current treatment guidelines and references for chronic diseases, drug interaction guidance and medical specialties will help save lives,” said Donato Tramuto, founding partner, CEO and vice chairman of Physicians Interactive Holdings. “Health eVillages will arm clinicians with a ‘gold standard’ medical reference tool-kit, so they are prepared for any situation and are able to properly treat even the most unique medical conditions.”

“For four decades, the RFK Center has been working on the cutting-edge of social change with human rights activists around the world,” said Kerry Kennedy, President of the RFK Center for Justice and Human Rights. “Article 25 of the Universal Declaration of Human Rights recognizes the right to healthcare. With this new program, we’re harnessing the capacity of cutting-edge technology to bring healthcare to the neediest people on this earth — people in Kenya, Haiti, Mexico and in the poorest places of the United States.”

Health eVillages is comprised of leading international healthcare advocacy organizations, mobile healthcare solution providers, health information technology companies, communication providers and public health foundations. They will provide healthcare professionals in disadvantaged areas with new and refurbished mobile phones and handheld devices that do not require Internet access and are preloaded with clinical decision support reference tools to ensure caregivers and patients have access to updated medical references in remote locations. All devices include drug guides, medical alerts, journal summaries and references from over 50 medical publisher resources powered by Skyscape.com, Inc.

To date, Health eVillages has conducted pilot projects in several regions, including Haiti, Kenya, Uganda and the Greater Gulf Coast. The Health eVillages advisory board is comprised of accomplished executives that have played a critical role in the healthcare industry throughout their careers and bring vast knowledge, dedication and insight to the Health eVillages program.

Members of the Health eVillages Advisory Board include:

        
        --  Kerry Kennedy, co-founding partner and president of the RFK Center for
            Justice and Human Rights
        --  Donato Tramuto, co-founding partner, CEO and vice chairman of
            Physicians Interactive Holdings
        --  John Boyer, chairman of the board of directors for Maximus Federal
            Services
        --  Glen Tullman, chief executive officer of Allscripts
        --  Steve Andrzejewski, former chief executive officer of NycoMed, Inc.
        --  Alexander Baker, chief operating officer of Partners Community
            Healthcare
        --  Dr. Mary Jane England, former president of Regis College
        --  Neil Versel, freelance healthcare journalist

For more information about Health eVillages, please visit www.HealtheVillages.org .

The following are suggested tweets announcing the news. For more information regarding Health eVillages via Twitter, please follow along at @PI_Posts and at @SkyscapeInc.

        
        --  New healthcare consortium to provide clinicians w/ Internet-free

http://ow.ly/6C2RQ                (5 Characters)
        --  RT @SkyscapeInc Breaking from #health2con: @rfkcenter & @PI_Posts

http://ow.ly/6C2RQ                Characters)
        --  @HealtheVillages announced at #health2con to bring vital #mHealth

http://ow.ly/6C2RQ                Characters)

About Physicians Interactive Holdings Physicians Interactive Holdings, with its subsidiary Skyscape.com, Inc., is the leading resource for healthcare information, medication samples and mobile decision support tools to medical professionals everywhere. We use the full power of our network to bring clinicians and Life Sciences Companies together in ways that will change the practice and business of medicine, for the better. Physicians Interactive Holdings has developed a foundation of user-generated, proprietary and public data that powers a networked suite of transactional applications, including eSampling, interactive learning programs and mobile solutions. Physicians Interactive Holdings is owned by Perseus LLC, a merchant bank and private equity fund management company. For more information about PIH, visit http://www.physiciansinteractive.com

About the Robert F. Kennedy Center for Justice and Human Rights The Robert F. Kennedy Center for Justice and Human Rights was founded in 1968 by Robert Kennedy’s family and friends as a living memorial to carry forward his vision of a more just and peaceful world. Through long-term partnerships and cutting-edge methods at the Center for Human Rights, we engage in long-term partnerships with human rights activists who have won the Robert F. Kennedy Human Rights Award to initiate and support sustainable social justice movements. We support authors and investigative journalists who bring light to injustice through the RFK Book and Journalism Awards. Our Speak Truth To Power program educates the public and provides students with a toolkit for action to create change in the classroom, the community, nationally, and internationally. The RFK Compass Program works with institutional investors to advance a discussion of the connections among investment performance, fiduciary duty, and public interest issues to optimize risk-adjusted rates of returns and address current and future global challenges. Partnering with RFK Europe, we provide human rights education advocacy programs to schools and communities across the continent. With RFK Children’s Action Corps, we urge legislative reform of juvenile justice systems. The Robert F. Kennedy Center for Justice and Human Rights is a 501 (c) (3) nonprofit charitable organization.

September 26, 2011 I Written By

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

So, now, doctors guessing with Google has become a joke

As I heard at AHIMA’s Legal EHR Summit earlier this week, clinical decision support isn’t a perfect science. (Check InformationWeek Healthcare for coverage on Thursday or Friday.) This is especially true when doctors rely too much on Google and don’t actually verify what they find on the Internet. This may sound hard to believe, but not everything posted online is true.

Now, the notion that doctors guess with Google has made its way onto the funny pages, specifically in the cartoon Sherman’s Lagoon. To wit:

 

 

Hopefully, your own doctor is more qualified than Hawthorne.

August 17, 2011 I Written By

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