I just started writing for Health-IT World and a story on Illumisys is my first. For those who don't know, Illumisys is a business division of Lumetra and has drawn their service offerings from their highly successful DOQ-IT Program for CMS. Click here to read the story!
Below is a question posed by Doug Barney in a recent issue of his e-newsletter and I'm interested to see what my health blogger friends think about the issue of blogs taking over the established press/media!
BLOGS VS. PR: AND THE PRESS WINS! Microsoft's Robert Scoble may not be as famous as Gates, Ballmer or Allchin, but among blog freaks, he's a bit of a hero. Scoble has also, apparently with Redmond's full permission, changed the way Microsoft discloses product plans.
For the better part of two decades, Microsoft and its PR firm have worked to carefully control access to executives and information. The company has taken the concept of message discipline to heart, and one can sense a real paranoia sometimes when execs are caught off-guard, terrified of saying the wrong thing.
Scoble is a rebel in this world of message conformity, and the blog SiliconValleyWatcher.com has taken notice. Check out the link -- it's an interesting read on the role of PR in a world changed by blogs. Of course, being blogs, they think blogs are taking over the entire world, killing off print pubs, Web sites (unless they're blogs) and eventually I guess TV and movies (I can see bloggers dominating the Tony's, Emmies, and Oscars).
One of my former "hats" was that of risk manager. Once you have been one, you can never seem to really take off that "hat", so here is a link to an article in Advance for Health Information Professionals that addresses hospital's maintaining a complete legal record of a stored EMR that compiles defined information as fulfilling legal requirements.
We never want to forget that there will be times when quick access to a complete medical record will needed.
Well, it finally happened! As a result of my visit to an emergency room in Santa Barbara County on Friday afternoon, I am a patient/consumer of the Santa Barbara County Care Data Exchange (SBCCDE)! I checked into the emergency room and of course had to repeat health history information found on my personal heatlh record (PHR) (which no one in the ER had access) to the various caregivers. I had a lot of lab tests, an ultrasound, a CT Scan and then the x-ray.
The technician asked whether I had a history of radiology tests and then mentioned that he did not see any at other providers here in Santa Barbara. I asked if he knew this because he was using the SBCCDE and he said "yes" (a bit surprised by my question). I explained that I had worked on the project and was really excited to learn that it was being used in my care.
The staff at the hospital were great! I saw many examples of technology being used in my treatment, but also saw opportunities for improvement -- access to the information on my PHR is the biggest. However, it takes time to put all of the pieces into place. I'm just happy to know that the SBCCDE is available for me!
I'm reading The World is Flat by Thomas L. Friedman and am fascinated by what I have read so far! Mr. Friedman is doing a great job defining the flattening of the world and is now (for me) describing how it came to be. I love the history of economics, so I highly recommend this book along with my all time favorite the Social Transformation of Medicine by Paul Starr.
One concept that is of particular interest to me is the one of "home-sourcing". The growth of information technology has made "offshoring", which is transferring jobs around the globe, possible. However, home-sourcing is bringing some of these jobs back, to homes around the US. Yes, many of these jobs are landing in the hands of women, and some are working mothers or workers transitioning to retirement. (Have you seen my writings on workplace effectiveness yet?)
Anyway, a good article to give you the overview can be found at CFO.com. Yes, the financial guys are interested in the benefits!
I came across some interesting findings on Michigan hospitals' adoption of computerized physician order entry (CPOE)-- a major building block of EHR systems. It seems that a report Blue Cross Blue Shield of Michigan and the Partnership for Michigan's Health found that the rate of adoption is almost twice the national average.
According iHealth Beat approximately 10% of Michigan hospitals have implemented computerized physician order entry, compared with a national average of 5.6%. Although many Michigan health care providers have been successful in implementing electronic health record systems, less than one-third of the state's acute care hospitals have comprehensive systems, according to the report. The report also found that inconsistent coding systems between providers, a lack of promotion and varying computer systems between hospitals are barriers to adopting a statewide system.
HFMA has come up with a quiz for providers who want to assess how successful their organization is at meeting the needs of the uninsured and underinsured? Any provider concerned about the un/underinsured should take the quiz Are You Prepared to Care for the Growing Uninsured Population?
This is not a drill! Your organization must have effective policies and procedures in place to appropriately administer care to uninsured patients. Satisfied that you're where you need to be? Find out where you stand:
1. My staff knows who qualifies for discounted or free care.
a) Yes b) No
2. My staff can explain the patient's options for handling any balance due to us. a) Yes b) No
3. My organization knows (and has a clear description) of patients who qualify for each discount level. a) Yes b) No
4. When asked, both my staff and patients would all say our uninsured policies are clearly communicated to all. a) Yes b) No
5. My organization's staff understands where services to the uninsured fit into our mission, as well as the relevant legal and regulatory context of our policies and procedures. a) Yes b) No
Source: John Wayne Zimmerman, MBA, CIW hfma Internet Strategy and Development 708.492.3322 firstname.lastname@example.org
Think of it as part of your disaster preparedness plan!
Frontiers of Health Services Management received a letter to the editor on their recent EMR/EHR issue. Basically the writer said that in healthcare we have been working on this issue for at least 40 years and he cautions us not to get "overly optimistic about the prospects for dramatic improvements in the immediate future." Well, I am an optimist (and proud of it), but also see something that has never existed before -- multidisciplinary dialog and widespread community-wide collaboration with the point of care at the center!
While I haven't been at this for 40 years, I have been working in healthcare for over 25 years and have never seen such a uniting of diverse stakeholders with common goals. Nor, have we ever had leadership (effective or otherwise) to establish a vision, communicate a mission and guide the process of fixing such an inefficient system. As I have addressed in some of my weblog posts and in my guide for establishing a RHIO, the NHII is really just one big performance improvement effort and the many community collaboration projects, while smaller are no less important.
So, if we truly believe in the power of continuous quality improvement and the teachings of Dr. Deming then there is no reason we can't make significant progress by 2014. I respectfully disagree with Paul B. Hofmann, Dr.P.H., President of the Hofmann Healthcare Group in Moraga, California, and I challenge all of my readers to comment on this issue -- because real sustainable change can only occur if we openly acknowledge the good, the bad and the ugly!
The other day I had a conversation with one of my HIT connections in the Sportsman's Paradise and he used a term that I use periodically with family and friends, but don't hear often in professional circles anymore. He used the French word lagniappe,which means "a little something extra." It is similar to a "Baker's Dozen", but in Louisiana it can apply to anything! For example, if I buy 10 lbs of brown shrimp the the fisherman might throw in an extra pound -- or maybe a Redfish (more likely in the old days!) Or, the cleaning lady might take it upon herself to make a fan-fold in my box of Kleenex or set out a little vase of flowers when she is done. The extra shrimp, Redfish, dressed up box of Kleenex or flowers are lagniappe!
So, you say, what does this have to do with this weblog or HIT! Well, I say that my weblog is lagniappe-- a little something extra for those that follow my work or engage me as a consultant or resource. In addition, I see many people around the country currently giving their time to help others plan for and develop RHIOs and contribute to the National Health Information Infrastructure. Mark Frisse at Vanderbiltand many others are stepping forward to help Louisiana recover and rebuild New Orleans' system of healthcare. Jan Root at UHIN and Holt Anderson at NCHICA gladly put their work/life aside to accept invitations to speak a new gatherings of stakeholders or make presentations at conferences. Sure, they or their organizations may derive some benefit or fulfill an obligation to funders to help others, however, I often see these people doing more than what is expected!
So, I say that every now and then, we need to stop and recognize these acts for what they are -- a little something extra -- lagniappe!
In October 2005, I wrote about my Personal Health Record. I've kept it up todate but have one complaint I'd like to share. None of my doctors have signed up, even though it is the PHR of the American Medical Association. As a result, I don't see myself creating one for my family members -- yes that task would fall to me.
I've read a lot about uploading payer information into PHRs and think this is a wonderful idea. I'm also afraid to say that PHRs tied to payers may be the most successful model since doctors will have an incentive (pay) to participate.
So, I don't even know if the theory of the baby book effectcan be assessed in my family, because I can't really test the PHR when my doctors don't participate. All I do know is that there is no one to read the data I've recorded in my PHR! So, it is unlikely that anyone else in the family will have one! Unless of course, our health insurer offers a PHR!
The newly updated Strategic Plan for the Santa Barbara County KIDS Network is now available and health access is one of the priorities for 2005 - 2008. For more information on the status of children and families in Santa Barbara County visit the Scorecard.
I just read about placing patient health data in the form of a Continuity of Care (CCR) record on a cell phone and want to carry the idea a little farther. Claudia Tessier described the Continuity of Care Record (CCR) as the ideal dataset to store a consumer’s personal health information on a cell phone
(Her presentation can be found at www.mohca.org.) It includes the following data:
Plan of Care
I'd like to see this information available on other electronic devices like MP3 players! Can you imagine your pre-teen to young adult having asthma or diabeties and their health infomration being available on their iPod Nano? These "kids" don't always have a cell phone, but access to an iPod like device may be more appropriate and attainable for many families. I believe that parents of children with complicated medical conditions or chronic diseases will jump at the chance to load their child's health information on an MP3 for healthcare providers to use in an emergency or even for routine care.
Also, think of the baby boomers shedding the ties of a cell phone as they retire. Some may trade their cell phones for iPods so they can listen to the Stones and Bread instead of goofy ringtones and keep their private health information handy.
Yes, I read alot! So, here is another article that I really liked. It is in Fast Company March 2006. The reason I liked it so much was because it helps put what has happened with HIT in focus. My favorite concepts are:
It's a cycle of boom, bust, and sustained growth (a golden age, if you will), followed by decay when a better mousetrap comes along. Think of CHINs and I guess that means RHIOs are the better mousetrap.
Capacity, or rather, overcapacity, is the key to progress. And broadband is the new railroad, the new highway system, the new electricity. ...we have almost more capacity than we know what to do with it! That means there is plenty of room to exchange all of those health records electronically!
It took electricity to have a serious impact on the US economy, after all, but by 1930, virtually every home had juice and it was driving refrigerators, toasters, lamps, radios, and other appliances. As Henry Blodget put it, our exuberance, irrational or otherwise, builds industries. This means our current exuberance for HIT and RHIOs will build the NHII! Unless of course, a better mousetrap comes along. However, we will have still progressed and learned something!
Of course, any leap into the unkown leaves some bodies broken on the rocks below. After the introduction of electricity, the US population grew by 15% between 1910 and 1920, but the number of personal servants fell 25%, replaced, in large part, by appliances. I think we already know that the efficiencies realized with HIT and the NHII will lead to a decrease in the need for some human resources, like mail room staff and file clerks!
Downside: the threat to privacy will get worse before it gets better. This is of special concern to those of us involved with health information technology.
Historian David Nye wrote, "People do not merely use electricity. Rather, the self and the electrified world have intertwined." The Internet, too, is being braided into our lives, and that will probably make us stronger -- even if it leaves a few of us hanging." Wonderful parting words that I hope will convince you to at leave skim the article!
After I finished writing this I came across yet another article and think the above post responds to the concerns expressed by Health Data Management. Happy reading!
I came across a white paper from Healthwise, "It’s a Jungle Out There: How Information Therapy Can Tame the Forces of Pay for Performance and Consumer-Directed Care by Healthwise and it focuses on improving patient education. There are a couple of concepts that I found interesting.
1.The paper reviews the concept of "managed consumerism," which looks to be the driving force of health care economics in the coming decade and calls for:
Using provider incentives, like P4P, to control the cost and quality of provider-induced demand.
Using cnsumer incentives, like a health savings account, to control the cost and appropriateness of consumer-sensitive demand.
They point out that the financial incentives to hospitals are only part of the motivation and that no hospital wants the public to see its quality ranking fall below average on any measure.
2. The paper introduces information therapy as a new tool for patient education and it involves three components:
information triggers with predict the patient's moment in care.
the patient's moment in care defines the questions and decisions that the patient is likely to face
the information prescription delivers targeted and tailored messaging and content to help answer the questions and support the decisions.
What came to my mind when I read this was Similac - the baby formula. Back when I was a new mom I signed up with them to receive information relevant to my condition (pregnancy). Periodically I would receive things in the mail educating me about caring for myself and a newborn. Then when we neared the time when the baby was due I received lots of coupons (for Similac) and more information. I continued to receive coupons and information until the point when my child(ren) was/were no longer on formula.
I always found it interesting that they knew just what to send me and when, although I knew I had shared my due date and they could figure it out from there. Also, as I used the coupons they knew to send me more to keep me loyal. And, this is information therapy in my mind!
What is information therapy in your mind? How do you see it working with P4P and consumer-directed healthcare?
Researchers supported by AHRQ found that nearly 15 percent of children in ambulatory pediatric settings were dispensed 22 common medications at a potentially incorrect dose based on their weight. Approximately 8 percent of medications were potentially dispensed in doses that were too high, while 7 percent were dispensed in doses that were potentially too low. For children who weighed less than 35 kilograms (77 pounds), only 67 percent of prescriptions were within recommended doses; 1 percent were dispensed at more than twice the recommended maximum dose. Researchers, led by Heather A. McPhillips, M.D., Assistant Professor of Pediatrics at the University ofWashington and Children's Hospital and Regional Medical Center, Seattle, reviewed automated pharmacy data for claims for the 22 medications prescribed to 1,933 children. Each drug was prescribed to a maximum of 122 patients. They also found that drugs dispensed for the treatment of pain (analgesics) were the class of drugs mostly likely to be prescribed in too high a dose (15 percent) and that drugs used for the treatment of epilepsy (antiepileptics) were the class of drugs most likely to be prescribed in too low a dose.
It makes you wonder what the return on investment would be for implementing health information technology to reduce/minimize these errors and associated risk!
The National Hospital Service Performance StudySM was based on responses from 2,500 patients who stayed in a hospital for at least one night within the previous three to nine months of being surveyed It found that three-fourths of patients used reputation-related information as their primary criteria in selecting a hospital. This translates to reputation playing a vital role in influencing a patient's choice of hospital!
Nearly one-half (48 percent) of patients said that the hospital's overall reputation was their primary criterion for selection, while 25 percent said the availability of good doctors and having skilled nurses on staff was most important in their selection.
The study measured overall patient satisfaction in five categories: dignity and respect; speed and efficiency; comfort; information and communication; and emotional support. Patients overall were very satisfied with the service they received during their most recent hospital stay, with 74 percent of patients giving the hospital high ratings regarding their hospital experience. Hospitals received the highest ratings from patients in the area of dignity and respect. Conversely, patients have consistently given hospitals the lowest ratings for speed and efficiency, with only 36 percent of patients indicating they were delighted. (An opportunity for improvement using HIT?)
1) Bottom line performance is not improving. Efficiency and cost cutting policies are not working. While hospitals have been going out of business at a rate of one hospital every 8 days for the last 30 years, the bankruptcy trend has started to accelerate in 2005.
2) Cutthroat competition to our medical centers include medical tourism. Medicare and Medicaid recent reimbursement reductions have made it harder for medical centers to survive. Competition from diagnostic testing facilities, ambulatory surgery centers and specialty hospitals are growing at record rates. India has recently become an early threat with two (2) hospitals that have been approved by the JCAHO.
3) Public is losing confidence in our hospitals. 35% of patients indicate a likelihood of not returning to the same hospital. 41% wouldn't recommend a hospital to their family.
4) Staff satisfaction is low. Nursing shortage of more than 1 million nurses as well as significant shortages in pharmacists, lab technicians, and other technical employees are expected by 2010. The hospital working environment is a key contributor to the 20% average burnout and staff turnover.
5) Lawsuits are on the rise. Medical malpractice has grown at an annual rate 30% faster than for all U.S. tort cases. The average malpractice settlement more than tripled from $95,000 in 1986 to $320,000 in 2002.
Southern California Hospitals!
To bring this all home, another study by the Los Angeles County Economic Development Corporation, for the Hospital Association of Southern California, found that hospitals in Southern California in 2004 accounted for about 12.1%, or about $85.5 billion, of the region's economy. Thestudy found that hospital expenditures exceeded revenues for this period at over 50% of the hospitals and that $8.2 billon will be spent on construction projects (bricks and mortar) in part due to population growth and strict seismic safety rules (an unfunded mandate.)
As we continue to move toward a National Health Information Infrastructure and find a place at the table for hospitals, we need to keep these realities in mind!
Safe Children and Healthy Families are a Shared Responsibility: 2006 Community Resource Packet [includes poster].
Written in both English and Spanish, this information packet contains resources designed to help communities, organizations, and individuals raise public awareness about supporting families and preventing child abuse and neglect. The packet includes the following: an overview of family support and how it can help prevent abuse and neglect; what organizations can do to promote safe children and healthy families, including building on family strengths; tips for building successful collaborations; ways organizations can develop and deliver effective messages to promote family support; examples of community awareness activities including a sample article written for the Opinion/Editorial (OpEd) section of a local paper.
I attended the CalRHIO meeting earlier this week and wanted to share some highlights from my perspective. You can also check out the SF Biz Journal article.
Dr. Brailer spoke and confirmed my belief that engaging stakeholders is the new frontier! He believes that over time RHIO's will begin to move away from the role of technology operators to take advantage of technological efficiencies -- and I agree! It is the natural progression of what we see in other areas of technology today!
There was also a funder panel which seemed to shed some light on reality! They commented on the following topics:
Evolution of adoption of standards to support interoperability
The major source of data is in health plans and their is a need to move this data into an environment to share.
Encouraging trust and holding goal of improving healthcare out front.
So many providers in CA: Who pays? What about info from community clinics? Legal aspects: class action lawsuits.
Foster variety of things going on then set a date for evaluation.
Creating a space where people feel free to share data and a benefit to flow down to physicians (identify/define benefits.
Will all Americans have a PHR by 2014? NO!!!! The panel agreed that access needs to be addressed and that interoperability will be in place - but not all Americans Will have a personal health record. One member gave the example of baby books and asked those of us who have children if we completed one for our 1st child. Then , he asked if the baby book for the second child was as complete. Then he asked if we even had a baby book for our third child! Not many people in the room had a complete baby book for each child and unfortunately, for some in our society I think that PHRs will be similar.
What is missing? Consumers asking the tough questions of us!
Government Health IT had a great article on How to start a community health network. The top takeaway is the importance of identify a convener who can properly guide the stakholders! Dictators need not apply!
Starbucks Coffee Company Launches California Giving Program
The Starbucks Coffee Company (http://starbucks.com/ ), building upon its tradition of investing in communities where it does business, has announced the launch of the California Giving Program, which will showcase and support local nonprofit organizations and charitable agencies throughout the state of California by awarding grants totaling up to $1 million.
The focus of the program is to support and fund programs, services, or projects that allow children the opportunity to grow and flourish. Besides the cash grants, Starbucks is committed to the long-term support of the program’s grant recipients through the volunteer efforts of the company’s more than 28,000 partners based in California.
Each grantee will be teamed with a Starbucks partner who serves as an ambassador for the organization -- driving enthusiasm, support, and volunteer hours for the grantees among Starbucks partners, customers, and the local community.
To be considered for a grant, applicant organizations must be California-based 501(c)(3) nonprofit organizations with programs, services, or projects that focus on creating better futures for children.
Complete grant program information is available at all California Starbucks retail locations as well as at the program’s Web site. Visit the Web site to apply. (Only online applications will be accepted.)
The theme for the 2006 Congress on Healthcare Leadership is ...Gaining Momentum. I've mentioned it in an earlier posts, but want to revisit the fact that Holt Anderson from North Carolina and I are presenting on the topic of establishing a regional health information organization at this conference, which is attended by at least 4,500 healthcare administrators.
For the last couple of years I have wanted to see a gain in momentumwith hospital administrators becoming more aware and supportive of community collaborations to electronically exchange health information for the improvement of healthcare quality, safety, efficiency and access. While administrators are becoming more and more involved, we still have room for improvement!
So, if you are planning to attend Congress this year and want to learn more about how you can support the national health information infrastructure, consider signing up for session #87 Establishinga Regional Health Information Organization. If you had not planned to attend, but want to learn more about the educational sessions at Congress visit the online brochure and/or share it with others.