Christina's Considerations

Swine Flu Advisory

The CDC has released an  advisory regarding the reported cases of swine flu and will continue to post updates on their swine flu site.  It is recommended that persons with febrile respiratory illnesses who are in the affected areas or have come into contact with persons in the affected areas, should stay home from work or school to avoid spreading the infection in their community. 

Do call your doctor, but don't go to the hospital unless you would have don't so regardless of whether you might have swine flu.

Frequent handwashing is one of the best ways to reduce the spread of infection and should be used by anyone for prevention of illness.  If you must come in contact with others, try to remain at least 6 feet away from the person(s).

For more on pandemics (which this is not yet) visit my prior posts:  Pandemic flu still a possibility and The Great Influenza.

It is the customer's fault!

I can see it now -- visions of stimulus funding dancing in heads the heads of administrators, doctors, and IT staff, but the reality is sometimes an expensive EMR sitting alone in the corner gathering dust while the piles of paper records continue to build.

Now who would really blame the customer?  Well in many cases I would and I'm not alone.  Austin at Software Advice explains why in his post  Get Redy for EHR Failures and describes the risks associated with too much "free" money.  

My Effective Management of Technology Implementation article (July 07 JHM) and an upcoming research paper in JHM both address the importance of planning, communication, education and training in any HIT implementation.  The stats Austin provided need to be a wakeup call for anyone involved with distribution or request for funding.

• 40% attribute failure to poor planning and communication

• 20% cite mismanagement and rejection by end users and

• 15% blame overspending

We really do need to get this right!

Grace in the workplace

This morning I checked out one of my fellow bloggers to catch up a little and see how others are using their voice.  Dr. Halamka's post on apologizing with candor and grace speaks to what I believe is the responsibility of our leaders and all employees in the workplace.  Since our leaders set the example and establish the culture of the organization, it all starts with us/them.

This post describes the conditions that will prevent the need for my post from the same day Speaking Up, Staying Put, or Getting Out. 

Thanks Dr. H. for saying it so eloquently!

Pandemic Flu: Still a possibility!

The last issue of Modern Healthcare includes an article on pandemic flu that reviews concerns about by the CDC and others that hospitals are ill prepared for a serious outbreak.  Yes, their are cases of the flu jumping from birds and pigs (2 recently here in CA) to humans, but the human to human leap hasn't yet been reached.  But, we all know it will one day and again I highly recommend the book The Great Influenza if you want a picture of what it will be like. 

But today, I want to address the concerns and the acknowledgment that other priorities are shifting attention away from preparedness efforts.  From my perspective, hospitals, County public health and other providers do continue to plan for a pandemic and excercise these plans for staff training.  Unfortunately, there are a multitude of ever changing priorities and limited resources, but most hospitals are balancing and doing what they can to prepare for whatever may come their way.

For example, hospitals and others continue to build caches of supplies and equipment and drill on various scenarios - surge, mass casualty, pandemic, alternate care site, evacuation, etc.  Even though the drills may not be specifically on pandemic, they do help staff continue to develop the skills and confidence needed to think on their feet and to make decisions when faced with the unpredictable nature of any emergency situation.  I agree we need to continue to fund preparedness planning and research in pandemics, but don't see the decrease in funding being necessarily bad.  Especially, if that funding continues to support local response training and preparedness activities.

As an administrator, I know to implement the hospital command center using HICS methodologyfor incident management. We drill on applying applying the methodology to emergency operations plans and our hospital's preparedness and then incorporate our learning back into the planning process. It is the repetitiveness of understanding our specific roles in meeting expected needs that helps hospital employees respond to ensure that we can provide the needed healthcare services.  Preparedness is a process, not a destination.

As a society, and taxpayers, we need to support hospital and local preparedness efforts to respond to any disaster (fire, flood, earthquakes, hurricanes, pandemic, surge, evacuation, mass casualty, bioterrorism, etc.).  We need to learn more about our own community's preparedness and the role of our local hospital(s).  We need to participate in community-wide drills and volunteer to help our hospitals with their efforts.  Most importantly, we need to prepare ourselves and families to stay healthy and safe during and after an event so we don't unnecessarily contribute to the strain upon the hospitals.

Speaking Up, Staying Put or Getting Out

I've studied and experienced workplace dynamics and cultures and have only come across really deep system-wide dysfunction twice in my career.  Once in a client organization and the second as an employee.  The former is now being forced to change (after many unfortunate years), because we all know that if you won't do it on your own, sooner or later someone will be brought in to do it for you.  The latter is unfortunately, just as it was back then.

So, I found the article Speaking Up, Staying Put or Getting Out in H&HN to be a refreshing overview of the options employees face.  These are the same options I had to consider once in my career and I believe choosing to speak up, while preparing to get out was the right thing to do for both myself and my co-workers. 

I risked speaking up, because that is the only way to find out if real change is truly desired, or whether the ineffective leader(s) is moving through the motions to look the part.  Speaking up in a respectful manner does help improve the situation, but sometimes only for those you leave behind.  Most importantly, it provides a release for you as you navigate the turbulence of the dysfunctional work environment. 

Staying put (and shutting up) can be emotionally frustrating and difficult over long periods of time.  But, for the right person, in the right place at the right time, it can be a workable alternative.  It just wouldn't work for people who are really passionate - like me.

Getting out is the hardest, but the most important when you realize that change isn't likely anytime soon.  The decision to get out should be viewed as a process and may in fact result in an emotional exit prior to the physical act of leaving.  In my case, it was a process and involved preparing myself and others for the day when I was gone.  In the end, I am relieved and it is somewhat better for those I left behind.

My challenge is to healthcare and other leaders to avoid toxic work environments.  But if you find that you already have one, to be strong enough to listen, call it what it is and effect the needed change.  This is how leaders truly realize success and reach their goals - financial or otherwise!

New CA Deputy Secretary for HIE

Jonah Frohlich, MPH is being appointed today as the new CA Deputy Secretary for HIE.   Jonah's experience working to improve healthcare using HIT for chronic disease management and with HIEs, as well as, his perspective from a role at CHCF make him a great choice. 

I look forward to working with Jonah in his new role!

Since first posting this, I've come across a information which should help better understand the role of the new Deputy Secretary.   Position Announcement

Clinical Decision Support Tools

CDS for Medication Management is a "meaningful use" in my book and AHRQ is releasing an online copy of the first chapter of a HIMSS book  titled "Improving Medication Use and Outcomes using Clinical Decision Support: A Step by Step Guide".  I haven't read the book, but can attest to the quality of publications from HIMSS and respect the recommendation by AHRQ. 

Additionally, AHRQ has made materials available from a recent web conference on  ePrescribing and medication management.

If your organization is currently planning for implementing health information technology and accessing the new streams of federal funding, I highly recommend evaluating tools to improve medication use due the the high cost, complexity, risk of errors/reactions and ever changing options.

Disaster Response: Psychological First Aid for Children

Below are links to brochures (English and Spanish) to assist with the psychological needs of children in a disaster situation.  The three primary steps are to:  Listen,  Protect and Connect

PFA Children Spanish              PFA_Children English

Disaster Preparedness: Increasing Surge Capacity with Reverse Triage

I'm currently working on a hospital evacuation project and received information on a paper in Disaster Preparedness and Public Health Medicine on the subject of reverse triage and early discharge of hospitalized patients at low risk for untowed events.  While the assumption was to prepare for a surge, it could also be used in a situation requiring a complete hospital evacuation.  The paper reports that 44% of 3491 patients were suitable for early discharge, which could be completed within 24 to 48 hours.

I think this paper is required reading for physicians and nurses who are active in disaster preparedness or likely to be in a leadership role during an event.  I welcome any of you to let my readers know what you think.

Tax on Health Plans to support HIE

I just read that Vermont has a quarterly tax on health plans to support their HIE efforts and RHIOs.  I'm not typically one for additional taxes, but this one seems like it will help address the accrual of benefits issue -- at least in Vermont. 

I'd also suggest that any payments or contributions to an HIE by a health plan could be a deduction from taxes.

My hope is that the health plans step forward and take a more active and engaged role in supporting HIEs in 2009.

First Peanuts, Now Pistachios!

There is now an  FDA recall of pistachios from Setton Pistachio of Terra Bella, Inc. here in CA.  This follows the recall of peanuts  from PCA in Georgia.   Please periodically check the list of safe brands and refer back as needed to see if new sources have been identified.

Top 50 blogs on wellness, women's interests and work/life balance

The Deleware Employment Law Blog recently ranked the top 50 blogs on wellness, women's interests and work/life balance and Christina's Considerations made the list.  I'm honored and hope that my writings on the subject are helpful.

Also of note is that their April 3 post is of the top 100 employment law blogs.  I believe knowlege is king in this area and appreciate having the listing as a resource. 

What is an HIE?

Many readers are still finding my weblog as they search for What is a RHIO? and What is an EMR? EHR?.  Given the current attention to health information exchange, I thought I would anticipate the next question some of my readers will have and provide an answer for: What is an HIE? 

The NAHIT defines HIE as the electronic movement of health-related information among organizations according to nationally recognized standards.  As a result, an HIE is a process and the vehicle is an electronic health record on both the sender and receiver sides of the equation.  The RHIO is the formal structure for establishing policy and providing oversight.  Therefore, HIEs, RHIOs, and EHRs are all very important to our work to bring a patient's private health information to the point of care -- when he or she is interacting with their physician or other care provider.

An Unprecedented Opportunity: Lets Get it Right!

There are two recent papers addressing the federal stimulus funds for health information technology that I really enjoyed reading and I want to share these (and a couple of comments) with my readers.

The first comes from the California Health Care Foundation and offers recommendations for using the funds here in California.  I especially liked the emphasis on using the HITECH Act's funds for supporting health information exchange and the idea of it possibly being a pre-condition to obtaining funds for EHR use.  As I've mentioned before, I'm really afraid the funds will quickly dry up on EHR systems and we will still have silo's of information -- the new and improved electronic silo.  I agree with CHCF that health care providers must be connected in a manner that provides for the electronic exchange of health information to improve the quality and efficiency of health care.  

The State will also need to take an active role in the planning and leadership, but I rather they not take over.  It still needs to be a public-private partnership with a strong, efficient and effective governance structure.  Having just left a public service job, it really needs to be a non-profit organization so it can move like a butterfly and sting like a bee!

The second paper comes from the people at Manatt and provides a great overview for everyone.    They note that the bill leaves some issues open, including standards and technologies, governance structure, administrative requirements and contractual rules to oversee the NHII, but I'm relieved by this because it means we have some time to give these issues the consideration they deserve.  The paper also reinforces the importance of providers planning for use of the funding and the role the states and state-designated entities will have in building the health information exchange infrastructure.  I really like the comment about tying the means (EHRs) to the ends(HIE). 

A word about education.... none of this will really matter if we don't have a trained and knowledgeable workforce.  The Manatt paper reviews the opportunities available for colleges and other medical/health educational programs.  I look forward to seeing more training in community colleges, like Santa Barbara City College.