Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

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.

California HealthCare Foundation CEO Smith stepping down

This comes in late on a Friday, though not as late on the West Coast, where it happened: The California HealthCare Foundation announced that founding President and CEO Mark D. Smith, M.D., will be leaving the influential organization later this year. Over the years, Smith has been a vocal advocate for quality improvement via, among other things, health IT.

I’ve had the pleasure of hearing Smith speak and interviewing him several times over the years, notably at the 2009 American Medical Informatics Association conference and at the 2011 Health 2.0 conference. (Coincidentally or not, both took place at the San Francisco Hilton.) At AMIA 2009, I distinctly remember Smith asking why there wasn’t an Open Table-like service for getting last-minute doctor’s appointments. Not long after that, ZocDoc came along.

Here’s the text of CHCF’s press release:

California HealthCare Foundation President Mark Smith to Step Down

Founding leader of Oakland philanthropy will depart in late 2013

Dr. Mark D. Smith, who has led the California HealthCare Foundation (CHCF) since its founding, plans to step down as president and CEO at the end of year, the foundation announced today.

“It has been a great honor to lead the California HealthCare Foundation in its mission to improve the quality of health care for all Californians,” Smith said. “I leave the foundation knowing it is well positioned to continue this important work.”

During his tenure, Smith focused CHCF on catalyzing efforts to improve health care quality, promote greater access, and reduce the cost of care for the state’s most vulnerable and underserved residents. The Oakland-based philanthropy makes grants totaling approximately $37 million annually from a fund of $700 million. CHCF has granted over $500 million since Smith became the founding president and CEO in 1996.

“Mark Smith’s remarkable leadership over the last 16 years has focused the California HealthCare Foundation on a vision to improve the health care system where it matters most: in the clinics, the hospitals, doctors’ offices, and wherever Californians go to find care,” said Ian Morrison, PhD, chair of the CHCF Board of Directors. “While he recognized that the problems in health care are huge, Mark and his team were smart and innovative in targeting the foundation’s resources where they could most make a difference.”

Smith, 61, a physician and expert on state and national health policy, will continue his work as a member of the clinical faculty at the University of California, San Francisco, and as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital, where he has practiced since 1992, including during his tenure at CHCF.

Under Smith’s leadership, CHCF focused on improving the way health care is delivered and financed in California through a number of initiatives, including:

Promoting research and policy analysis. From its founding, CHCF has supported sound decisionmaking using evidenced-based research and nonpartisan policy analysis. CHCF has become a prolific publisher on issues of quality, access, and the financing of care covering both the commercial and public sectors.

Promoting transparency. The foundation has made significant investments in supporting transparency in health care delivery through publicly reporting quality data on hospitals, nursing homes, and long term care facilities, and building public websites that allow consumers to compare local facilities and provide health care leaders with benchmarks for improvement.

Improving clinical care. Smith focused attention on innovative ways to improve care delivery, including being an early proponent of using information technology at the point of care, challenging providers to deliver high-quality and cost-effective care, and promoting disruptive innovations like retail clinics and process redesign. He has also championed redefining the scope of work among clinical team members, to help ameliorate the need to train more doctors to do work that lower-cost members of the clinical team can deliver safely and effectively.

Training new leaders. The foundation initiated the CHCF Health Care Leadership Program at UC San Francisco in 2001. The two-year, part-time fellowship has trained 355 clinicians in management and leadership skills required to lead the state’s health care institutions in a rapidly changing and challenging environment. The program’s alumni now occupy leading positions in hospitals, clinics, medical groups, and government throughout the state.

Fostering innovation. The $10 million CHCF Health Innovation Fund helps accelerate innovation in care delivery by investing in new and emerging companies focused on lowering costs and improving access to care. While supporting improvements to the health delivery system, CHCF also has focused on the rise of alternative care delivery models such as retail clinics and the adoption and effective use of information technology.

Modernizing enrollment. CHCF has been a leader in promoting more efficient and consumer-friendly ways for eligible Californians to enroll in public programs. In 1999 the foundation supported the development of the first web-based eligibility and enrollment application in the United States, which it licensed at no cost to the State of California. More recently CHCF led the successful national public-private development of a first-class user experience design to streamline enrollment under the Affordable Care Act (ACA). The foundation has also recently focused on supporting the implementation of the ACA in California, and continues to monitor and report on its progress.

Supporting health care reporting. Recognizing the important role that the media has in promoting improvements in health care, CHCF has devoted significant resources to supporting health care journalism. Since 1998, the foundation has produced California Healthline, a daily digest of news, analysis, and opinion on the state’s health care system. In 2009, the foundation established the CHCF Center for Health Reporting at the USC Annenberg School of Communication and Journalism, which collaborates with media across the state on in-depth, explanatory journalism on critical health care issues.

“Mark has built a strong staff that is set on a steady course, focusing on the medical delivery and financing systems in California, with an emphasis on quality improvement, increasing both access and efficiency, and addressing the unsustainable cost of care to individuals and society,” Morrison said. “The board expects the foundation to continue building on its successes in these areas.”

“There is still a lot of work to be done. While I will assist the board and staff in making a smooth transition to a new leader, I will also continue to look for ways to make our health care system work better for the people of California,” Smith said.

A native of New York City, Smith earned his bachelor’s degree in Afro-American studies at Harvard (1979), his medical doctorate from the University of North Carolina at Chapel Hill (1983), and a master’s in business administration with a concentration in health care administration from the Wharton School at the University of Pennsylvania (1989).

Prior to joining CHCF, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Service and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine.

He was elected to the Institute of Medicine (IOM) of the National Academy of Sciences in 2001 and recently completed service as the chair of an IOM committee on “The Learning Health Care System in America,” which issued its report Best Care at Lower Cost in September 2012.

Smith will continue serving as CHCF’s president and CEO until a new leader is in place, which is expected by the end of 2013. The search for Smith’s successor will be conducted by the foundation’s board of directors. Inquiries should be directed to Carol Emmott of Russell Reynolds Associates at cemmott@russellreynolds.com or 415-352-3363.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

 

CHCF also released a statement from Board Chair Ian Morrison, Ph.D.:

The Philanthropic Leadership of Dr. Mark D. Smith

Ian Morrison, PhD, MA, Chair of the CHCF Board of Directors

The CHCF board of directors conveys its pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and reinforces its commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

 

January 11, 2013

The board of directors of the California HealthCare Foundation has asked me to communicate our pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and to reinforce our commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

We recognize and anticipate that our next leader will bring fresh ideas and energy that will take us in new directions. We are also firm in our belief that the California HealthCare Foundation will continue to play a central role at the intersection of the health care delivery system and the policy world that Dr. Smith carved out during his tenure.

We take great pride in the fact that CHCF is a respected resource for objective research, information, data, and analysis on a broad range of health care issues in California; a trusted convener; and a creative helping hand, spurring on innovation in the market and the policy community to benefit the health of all Californians. In reflecting on Dr. Smith’s extraordinary leadership, the board has identified 10 areas where the foundation has had particular impact.

All of these efforts have been shepherded by the foundation’s most powerful asset: its staff. Each board member will attest to the quality of people who work for CHCF: their energy, enthusiasm, expertise, and professionalism are truly impressive.

The consistently high standards of the foundation’s staff, grantees, and partners have resulted in a remarkable body of work that has made important contributions to improving quality, access, and affordability of health care services in California and the nation. This list samples from the many and various ways CHCF has made a difference. Dr. Smith’s leadership signature is evident in all of them and together they reflect the enduring DNA of this organization that we believe will carry on under his successor.

1. The Fruits of Conversion: The Orderly Creation of Two Important Philanthropic Foundations

CHCF was originally tasked with managing the sale of Wellpoint stock following the conversion of Blue Cross of California to for-profit status and transferring 80% of the proceeds to The California Endowment (TCE), our sister foundation. The founding CHCF board and staff under Dr. Smith’s leadership managed the process smoothly and created the endowment for TCE, which today has assets of $3.2 billion and annual giving in excess of $165 million. CHCF’s 20% of the proceeds amounted to almost half a billion dollars at the time, and Dr. Smith led the process of developing a complementary strategy and grants program. The result was the creation of two important health care philanthropies in the state: The California Endowment, which focuses on community-level initiatives to improve access and public health, and the California HealthCare Foundation, which focuses on policy and practice change in health care financing and delivery.

2. A Market Savvy, Policy-Relevant, Innovative, and Trusted Philanthropy

We are proud of our position as a trusted convener of health care stakeholders from the worlds of policy and industry. We value our reputation as an organization that simultaneously understands market dynamics and the intricacies of policy at federal, state, and local levels. Dr. Smith and the staff have built the capacity to navigate through this difficult terrain, but most importantly, to identify creative ways to intervene and play a catalytic role. Our board has strongly supported the identification of unique points of leverage on market-makers and policymakers alike to help improve quality, access, and affordability of health care for all Californians.

3. Support for New Leaders

Early in CHCF’s history, in collaboration with the University of California, San Francisco, CHCF conceived of a professional development program for clinical leaders in the state, particularly those serving in safety-net institutions. The purpose was to provide young clinicians with the leadership skills they would need to head their organizations in the future. The program currently has 355 alumni across the state and the board recently announced the foundation’s support for two new classes. The program has been emulated by other foundations and institutions in California, resulting in a total of more than 2,000 graduates across the state. Any meeting of California health care leaders is likely to include graduates of these programs, and many of them have become important grantees, partners, and champions for constructive change across California’s health care system.

4. The Adoption and Effective Use of Health IT

CHCF has always been known as a pioneer in the promotion of health information technology as an important tool to improve the quality, safety, and efficiency of care delivery. Some may point to our investments in the creation of the Santa Barbara County Care Data Exchange as taking a large risk (as we explored in a self-reflective 2007 Health Affairs special section). But as a board, we have been consistent in our support for investment and improvement in the use of new information technology in health care. And indeed we firmly believe that Santa Barbara was a catalyst for the significant federal HITECH investment that has followed.

While CHCF has had a long and important interest in promoting health IT to improve clinical care, we have also made special contributions in the seemingly arcane area of enrollment modernization. Building on Mark Smith’s and Vice President of Programs Sam Karp’s combined belief, interest, and expertise in the area, CHCF created important tools, technologies, and policy processes to help automate and modernize enrollment in public programs such as Medi-Cal and Healthy Families. Health-e-App and One-e-App not only enabled thousands of Californians to secure the coverage they were eligible for, but these pioneering efforts laid critical groundwork and built expertise in online enrollment and user experience design that has informed policy and practice related to implementing the Affordable Care Act in California and nationally.

5. Technical Assistance for the Safety Net

Much of CHCF’s work has involved deep engagement with public hospitals, community health centers, and county-organized health systems to improve quality, access, and affordability, particularly for patients with chronic conditions. Through a wide range of projects and initiatives, CHCF has supported chronic disease registries, electronic health records, telehealth adoption, quality improvement activities, and measuring and improving patient experience in institutions that lack the resources, capacity, or time to invest in delivery system transformation. These programs have helped improve access to care for specialty services for the underserved and the quality of care for patients with chronic illness, as well as improve the efficiency, service level, and throughput of overstretched safety-net providers.

6. The California Health Care Almanac and Information Services

CHCF plays an active role in monitoring the functioning and improving the transparency of health care policy and practice in California. Through a wide range of sponsored studies, custom reports, and news services under the broad rubric of the California Health Care Almanac, California Healthline, and iHealthBeat, the foundation keeps health care leaders informed about what is happening, what is important, and what lies ahead. The consistent quality and timeliness of this work has created a resource base that is relied upon by managers, policymakers, consultants, and academics, in the state and across the country.

7. CHCF Center for Health Reporting

CHCF recognized with concern that the ongoing transformation in media was undermining the economic viability of quality journalism in the health care field. The foundation created the CHCF Center for Health Reporting at the USC Annenberg School for Communication and Journalism to support high-quality reporting in partnership with media outlets in the state. The results can be seen in the number of stories produced in state and local media and their impact on the policy discourse on important topics, including the performance of Denti-Cal plans, the public conversation on end-of-life issues, and variation in the quality of care delivered across the state.

8. CHCF Health Innovation Fund

CHCF has committed $10 million over three years to invest in new ventures that have the potential to reduce the cost of care or improve access for the neediest Californians. The fund is off to an exciting start with several important investments in promising start-ups that we hope will create lasting value and improvement in health care delivery in areas such as telehealth access to specialists, better asthma management, and more efficient pharmacy services for rural and safety-net institutions. The fund is at an early stage, but we are excited by the prospects for this program-related investment (PRI) vehicle to innovate in areas of greatest need that the market might have overlooked without our help.

9. End-of-Life Care

End-of-life care has become a focus of the foundation because of the wide gap between the way Californians say they want to spend their last days and the highly medicalized way that many of them die. The foundation has supported greater clarity in end-of-life wishes through use of POLST (Physician Orders for Life Sustaining Treatment) forms across the state. Major progress has been made in making this a standard of care. Similarly, CHCF grants and initiatives have enabled every public hospital in the state to establish palliative care programs over the last five years. CHCF remains committed to raising awareness of Californians’ wishes for the care they receive at the end of life and in supporting care choices that are consistent with those wishes.

10. Supporting Improvement in the Medi-Cal Program and the Implementation of the ACA

CHCF has joined with other foundations and has worked with policymakers and state agencies and departments to provide instrumental technical support for many dimensions of the Medi-Cal program and the implementation of the Affordable Care Act, including:

  • Informing the development of enabling legislation for the state-based health benefits exchange
  • Providing technical support on the development of Medi-Cal waivers
  • Developing performance standards for Medi-Cal beneficiaries with disabilities and monitoring and evaluating their transition into Medi-Cal managed care
  • Informing California’s implementation of coverage expansion and insurance market reform, health IT deployment, and quality improvement initiatives

This important work continues.

Over the course of the next year, there will be many opportunities to toast Mark Smith’s legacy and contributions, and also time to warmly welcome a new leader. As we embark on this journey, the CHCF board of directors is proud of CHCF’s past and confident in its future. With the board’s strong encouragement and support, Mark Smith and his team have created an important institution that will continue to serve Californians in the decades ahead, building on a rich legacy of creativity and innovation, as evidenced in these efforts we highlight today.

January 11, 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.

You want solutions for consumer ignorance about health IT? OK

Monday in FierceHealthIT, I wrote a commentary about a new study from the California HealthCare Foundation that found that consumers still equate more care with better care. The study, published in Health Affairs, concluded that evidence-based medicine is a foreign concept among the general public.

In my commentary, I derided the whole premise of the report. I mean, many people in healthcare aren’t completely clear about what evidence-based medicine is. I also criticized mass media for not doing a good job educating the public about quality of care, particularly in the sham of a debate over health reform in the last year or so. It’s not the first time I’ve said something to this effect.

Within three hours of my commentary being posted, one anonymous coward posted the following comment on the FierceHealthIT page: “So Neil, instead of the snark, how about some solutions? You’re a journalist – isn’t the public’s ignorance your failing?”

Well, Mr. or Ms. Coward, no, the public’s ignorance is not my failing. If I had had access to mainstream news outlets, I would have asked the tough questions of the politicians, policymakers and lobbyists, not fueled the red herring of a debate over whether healthcare reform was about government control or not. It’s quality, stupid. I continue to try to pitch mainstream media about freelance gigs, but, alas, everyone’s either cut their freelance budgets to the bone or they won’t give the time of day to someone they don’t know or who doesn’t have some kind of insider connection.

And, to Coward’s other point, I have offered some solutions. If you weren’t so knee-jerk in your anonymous condemnation of my snark, you would know that I recently wrote a piece for journalists about covering EHRs and related health IT topics.
It’s over on the site of the Reporting on Health project at the University of Southern California’s Annenberg School for Communication.

While you’re at it, you might want to check some of my other Fierce columns about how people both in the media and the health IT industry need to do a better job of communicating the issues. They’re not hard to find. In fact, here’s one to get you started.

Next time, don’t be such a coward. And an uninformed one at that.

June 9, 2010 I Written By

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