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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.

Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

 

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

March 14, 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.

HIMSS gossip

ORLANDO, Fla.—Two days of HIMSS14 have come and gone, and I’m not bouncing off the walls just yet. But I did bounce off the pavement Monday night when I tripped exiting a shuttle bus, and have some facial scrapes to show for it. You will see the evidence whenever Health Innovation Media gets around to posting a video interview I conducted Tuesday afternoon.

Health Innovation Media’s Gregg Masters and Dr. Pat Salber have been camped out near the HIMSS press room since Sunday with their video equipment, querying various newsmakers on various health IT topics, and occasionally having guest interviewers. As I walked out of the press room on my way to the exhibit hall, I said hello to former national health IT coordinator Dr. Farzad Mostashari, who looked like he was just hanging around, but was actually waiting to be interviewed. Masters and Salber asked me if I’d be interested in interviewing Mostashari right there on the spot with no preparation, and with just 15 minutes to get down to the show floor.

If you recall, I did a live interview—yes, streamed live on the Web—last year with Athenahealth honcho Jonathan Bush, beers in hand, for the Health Innovation Broadcast Consortium that Masters and Salber were involved in. (I don’t know the status of that project, as there’s nothing new on that site since last July.) So of course I said yes, and I think it went pretty well. Well, there were a couple of hiccups, as in me thinking we needed to wrap up earlier than we actually had to. And then there’s this:

 

Followed by this:

 

Yes, the Twitterverse catches everything.

Now about that facial injury. I think I just need to avoid Orlando. In 2011, the last time HIMSS met here, I needed six stitches above my right eye after I banged my face against the edge of the bathtub in my hotel room. As I arrived for the 2008 conference here, I turned on my phone after landing and got the message that my grandfather had passed away. Just for good measure, I passed through Orlando on my way back from Europe in 2009. As the flight pulled to the gate, the skies opened up with a violent summer thunderstorm, prompting the airport to close the ramp, preventing the ground crew from unloading bags for nearly an hour. I was stuck in the no-man’s land of U.S. Customs for that whole time, where cell phones are prohibited. It was not until I cleared security, took the airport tram to a different terminal, then hustled to the gate that I knew I would make my connecting flight. So yeah, it’s become a pattern.

Anyway, speaking of Jonathan Bush, he is not at HIMSS14 because he is on sabbatical to write a book and who knows what else? Well, here’s a clue. He was spotted at the Winter Olympics in Sochi, Russia, last week with his more famous brother, Billy, host of “Access Hollywood.” (Hat tip to HIStalk for showing this video at HIStalkapalooza Monday night.)

I also heard that Bush is considering a run for political office of some kind, perhaps because it’s, you know, the family business. Anyone care to confirm this?

I do know for a fact that at least one HIMSS attendee is actually seeking office. That would be Dr. Steven Daviss, CMIO of startup M3 Information, maker of a mental health screening app called My M3. Daviss is running for Democratic Central Committee in Baltimore this year. If he wins, he plans on seeking a seat in the Maryland House of Delegates in 2018, in part because he says there is only one other physician among the state legislature.

Daviss himself is on sabbatical from his job as chairman of psychiatry at the University of Maryland’s Baltimore Washington Medical Center in Glen Burnie, Md.

February 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.

HIMSS, Continua launch Personal Connected Health Alliance

ORLANDO, Fla.—As HIMSS President and CEO hinted at yesterday in his podcast with me, HIMSS today announced the formation of the Personal Connected Health Alliance, in conjunction with the Continua Health Alliance and the HIMSS-owned mHealth Summit.

This short video from HIMSS explains:

Also, Lieber mentioned that HIMSS has not signed on to a letter from 48 organizations—led by CHIME—to HHS Secretary Kathleen Sebelius, calling for more time and flexibility in meeting Meaningful Use Stage 2 requirements., Lieber said HIMSS declined to sign because the requests were, in his opinion, “very vague.”

Today, the letter, dated Feb. 21, was made public:

February 21, 2014
The Honorable Kathleen Sebelius
Secretary
Department of Health and Human Services
200 Independence Ave., S.W.
Washington, DC 20201

Dear Secretary Sebelius:

The undersigned organizations write to express immediate concerns confronting our respective members’ ability to comply with the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program. We recognize the vital role your department has taken in advancing the adoption of health information technology in the United States and appreciate your willingness to be flexible in extending the start of Stage 3 to 2017. We fear the success of the program is in jeopardy, however, if steps are not taken now to address our shared concerns.

Over the next seven months, more than 5,000 hospitals and 550,000 eligible professionals must adopt the 2014 Edition of Certified Electronic Health Record Technology (CEHRT) and meet a higher threshold of Meaningful Use criteria. Failure to do so will not only result in a loss of incentive payments, but also the imposition of significant penalties. With only a fraction of 2011 Edition products currently certified to 2014 Edition standards, it is clear the pace and scope of change have outstripped the ability of vendors to support providers. This inhibits the ability of providers to manage the transition to the 2014 Edition CEHRT and Stage 2 in a safe and orderly manner.

We are concerned this dynamic will cause providers to either abandon the possibility of meeting Meaningful Use criteria in 2014 or be forced to implement a system much more rapidly than would otherwise be the case. The first choice limits the success of the program to achieve widespread adoption of EHR, while the second is highly disruptive to healthcare operations and could jeopardize patient safety. As you know, our members’ number one priority must be to provide safe and high quality care to patients.

Providers need adequate time to learn how to use the newly deployed technology, including examining staff assignments, workflows, and practice processes. If providers move forward, as dictated by the current policy, our concerns regarding rushed implementations are heightened. Furthermore, we believe the “all or nothing” approach – where missing a single objective by even a small amount results in failure for the program year – compounds our concerns.

For these reasons, our organizations strongly recommend that HHS:
1. Extend the timelines providers have to implement 2014 Edition Certified EHR software and meet the Program requirements (Stages 1 and 2) through 2015;
2. Add flexibility in Meaningful Use requirements to permit as many providers as possible to achieve success in the program.

Given that we are well into 2014, immediate attention to these concerns is warranted. This additional time and new flexibility are vitally important to ensure that hospitals and physicians continue moving forward with technology to improve patient care. By making such changes, HHS would be demonstrating needed flexibility to maximize program success, without compromising momentum towards interoperability and care coordination supported by health IT.

We remain committed to the success of the program and look forward to hearing from you on this important matter. Please contact Jeffery Smith, Senior Director of Federal Affairs, CHIME, (jsmith@cio-chime.org) should you have any questions. Thank you for your consideration.

Sincerely,

AMDA-Dedicated to Long Term Care Medicine
American Academy of Allergy, Asthma & Immunology
American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Home Care Medicine
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Orthopaedic Surgeons
American Academy of Otolaryngology—Head and Neck Surgery
American Association of Neurological Surgeons / Congress of Neurological Surgeons
American College of Cardiology
American College of Osteopathic Family Physicians
American College of Osteopathic Internists
American College of Osteopathic Surgeons
American College of Physicians
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Health Information Management Association
American Hospital Association
American Medical Association
American Osteopathic Academy of Orthopedics
American Osteopathic Association
American Psychiatric Association
American Society for Clinical Pathology
American Society for Gastrointestinal Endoscopy
American Society for Radiation Oncology
American Society of Anesthesiologists
American Society of Cataract and Refractive Surgery
American Society of Hematology
American Urological Association
America’s Essential Hospitals
Association of American Medical Colleges
Catholic Health Association of the United States
Children’s Hospital Association
College of Healthcare Information Management Executives
Federation of American Hospitals
Heart Rhythm Society
Infectious Diseases Society of America
Medical Group Management Association
National Rural Health Association
North American Spine Society
Premier healthcare alliance
Society for Cardiovascular Angiography and Interventions
Society of Thoracic Surgeons
The Endocrine Society
VHA Inc.

Yes, that is kind of vague, but that’s what you get when you involve four dozen organizations. Will it be effective? As I mentioned yesterday, ONC Chief Medical Officer Jacob Reider, M.D., hinted that there will be news about Stage 2 flexibility, likely Thursday morning at a joint ONC-CMS town hall. Reider made that statement at the CIO Forum, hosted by CHIME.

 

 

February 24, 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.

Loudmouth patients, in their own words

The video from the Digital Health Summit session, “Loudmouth Patients: Making Noise and Making Change,” that I moderated in January has been posted. It was a lively, fascinating discussion involving: empowered patient Hugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

Unfortunately, one long-winded questioner from the audience took up all the Q&A time (and I initially mistook her for Bettina Experton of Humetrix), so some things went unanswered. If you have any questions for the participants, post them in the comments below and I will attempt to get the panelists to answer.

This discussion took place Jan. 8 at the Digital Health Summit at International CES in Las Vegas.

In case you missed it, here are some post-session interviews with Campos, Matthews and myself.

February 13, 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.

OpenNotes, changing roles in health IT and a Friday, um, funny

I’ve just had two new stories published on the US News & World Report Hospital of Tomorrow site: “OpenNotes Helps Keep Patients Informed and Engaged” and “The Evolution of Health IT Continues.” The latter is subtitled, “New roles signal new realities and priorities as hospital information technology changes,” and goes in depth and the changes underway in hospital HIS and HIM departments in response to various healthcare reform imperatives. I’d appreciate your feedback here, on the U.S. News pages and on Twitter.

Since it’s Friday, I’ll share something offbeat. I’ll let you decide if it’s a good idea or a gimmick. Nestlé Fitness has created the “Tweeting Bra,” with a Bluetooth-enabled sensor that sends a tweet every time the wearer unhooks the undergarment, reminding women daily of the importance of breast self-exams. Here’s a video, in Greek with English subtitles.

 

If you want more information, here’s a short interview with the keeper of the Tweeting Bra, Maria Bakodimus, a Greek celebrity. It’s only in Greek, without subtitles, but it does show the sensors in more detail.

If you want to get one, well, sorry.

 


It was a one-off prototype created for Breast Cancer Awareness Month in October.

February 7, 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.

More accolades for Topol as ‘connected health’ gains

I’m convinced that Dr. Eric Topol is one of those rare people, like Dr. John Halamka, who can function on minimal sleep, perhaps four hours a night. He just gets that much done.

Yesterday, AT&T named Topol chief medical advisor. As such, the company says, Topol will “impact the design, development and delivery” of connected health products and services for the AT&T ForHealth business. This is on top of his appointment last year as editor-in-chief of Medscape, his many speaking engagements and TV appearances and, lest we forget, his day job as cardiologist, geneticist and chief academic officer at Scripps Health in San Diego and leader of the Scripps Translational Science Institute.

Topol will not, however, be replacing Dr. Geeta Nayyar, who was full-time CMIO at AT&T until September.

This news comes a couple weeks after CBS News ran a segment on the possible demise of the stethoscope at the hands of the portable ultrasound.

 

This is not the first time we have heard this idea. Yes, it was Topol who dropped his stethoscope in the trash on stage at TEDMED 2009 and suggested that the handheld ultrasound should become the standard of care by the time the 200th anniversary of the stethoscope rolled around in 2016.

Given how slowly medicine moves, I wouldn’t bet on the stethoscope being extinct in the next two years; the cost of the GE Healthcare Vscan ultrasound, the one Topol demonstrated in 2009, hasn’t really budged since then. A new one will still set you back $7,900. I can’t see primary care physicians shelling out that kind of cash when the old technology is $200 or less.

Meanwhile, this week we get more evidence that “connected health” may be winning the terminology battle over mobile, wireless and digital health. The February edition of Health Affairs examines this field, which the policy journal says encompasses telemedicine, telehealth and mobile health. On the other hand, the lead author of one of the overview articles is Dr. Joseph Kvedar, founder and director of the Center for Connected Health at Partners HealthCare in Boston. He is the champion of the term, and possibly the creator of it.

 

 

February 4, 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.

Great news from Health eVillages

As a board member of Health eVillages, I’m proud to share this video from rural Lwala, Kenya, where clinicians and other health workers are harnessing the power of mobile technology to deliver better care and, for some people, the first real healthcare they have ever had. This video, from from when Health eVillages Co-Founder Donato Trumato and Program Manager Matt Linder trekked to Lwala in October, shows how mobile health is helping local women deliver healthy babies.

Subsequent to this trip, the Lwala Community Alliance highlighted the work of Health eVillages here. Then, at a Health eVillages board meeting in December, Trumato issued a challenge to raise $150,000 to construct a dedicated maternity ward at the hospital in Lwala by year’s end. Physicians Interactive, of which Trumato is CEO, pledged half that total, and then others far wealthier than I stepped up and helped Trumato met the goal by Dec. 26. Operating funds are still necessary, and Health eVillages (or “Heal the Villages,” as one partner has pointed out) wants to help more people, including some at a site in rural Louisiana.

Since 2012, Health eVillages has helped the Lwala Community Alliance cut early infant mortality in half (from 60 per 1,000 births to 31 per 1,000). However, the Lwala still area happens to have the highest HIV/AIDS rate in all of Kenya, so education, care and prevention are critical. Here’s an overview on the Health eVillages-Lwala Community Alliance partnership (.pdf). To donate, visit http://lwalacommunityalliance.org/donate/.

Thanks, and stay tuned for more updates.

January 26, 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.

Back from CES, and ready to, um, laugh about digital health

I got home from the Digital Health Summit at International CES in Las Vegas late Thursday night, and have spend most of the time since them just catching up on things. Among important news I missed was that Stephen Colbert took on health apps on Wednesday, specifically Doctor on Demand. Colbert joked that the app is going to “revolutionize medicine.” (“Why waste time getting an exam when you can just shoot your doctor an emoji of your shattered femur?”)

Ah, yes, revolutionary health apps. It has to be a joke, right?

“Clearly, app-based healthcare is the future of medicine,” Colbert continued, before introducing one of his own, from “sponsor” Prescott Pharmaceuticals.

The Doctor on Demand part starts around 3:30, but the earlier part is pretty funny, too. Some might be offended by this segment.

I will have more on the Digital Health Summit on MobiHealthNews and right here on this blog later this week.

January 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.

Patients raise their voices at CES

I’m about to escape the frigid winter blast in Chicago, a.k.a., Chiberia, for the relative warmth of Las Vegas (it will be below 40 degrees Fahrenheit at night, so it’s not exactly tropical there either) and the Digital Health Summit at International CES. On Wednesday afternoon at 4:10 p.m. PST, I will be moderating a panel called “Loudmouth Patients: Making Noise and Making Change.” Panelists will include: well-known empowered patient — and pain in Medtronic’s behindHugo Campos; Donna Cryer, CEO of the Global Liver Institute (and a liver transplant recipient herself); and Greg Matthews, group director of  interactive and social media at WCG.

I’m giving just a short intro since the session is only 30 minutes long, though I do intend to give a condensed version of the story of how I had to raise my voice in support of my dad, who was rendered unable to speak by a rare disease as he was dying — and being badly mistreated — in an ill-equipped and poorly run hospital less than two years ago.

Hopefully soon we can all speak up to our healthcare providers without being blacklisted like Seinfeld’s Elaine back in the 1990s (h/t Brian Ahier).

Speaking of patients getting a look at their medical records, I’m also working on a story for U.S, News & World Report about the pros and cons of the OpenNotes project. Stay tuned for that one hopefully later this month.

January 6, 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.