Christina's Considerations

California's HIT & HIE Strategic Plans

This summer has been a busy one for me.  When I wasn't writing my book or working on disaster planning, I had the privilege of participating in a couple of workgroups establishing the State of California's plan for health information technology and exchange.  In addition to the main group, I worked on workforce education and training and the governance sub groups.   Both of these have just released RFIs so please take a look.

Governance RFI  and  Workforce RFI

I'm trying to finalize the book and the disaster planning just picked up with pandemic preparedness, but the State's plan is in the final stretch.  If you are in California and want to comment on the draft HIT and HIE plans please visit http://www.hie.ca.gov/HIEPlan/tabid/72/Default.aspx.  I'd love to hear your feedback, so consider leaving a comment, or two.

I'll be sticking around and working on a new committee, so I'll always be open to your thoughts on the subject of HIE and HIT in California.

Baseball and Health Reform

Dr. Thomas Lee hit a home run with his presentation of the real issues surrounding a government run health plan in his commentary in iHealthBeat yesterday.  The article titled, Inside Baseball: The Great Debate about Government Run Healthcare, describes the challenge and comes down to this:

"The analog in baseball would be for Major League Baseball -- the corporate entity that oversees the game -- to field a team that competed with other MLB teams. And that this MLB-owned team could play by a different set of rules (didn't need to support its expenses, could have losses subsidized by taxpayers, etc).

One can imagine that such a team could hire the best players, charge less for tickets and potentially win the most games while running huge deficits.  Even if the MLB-owned team was forced to play by the same financial rules, it would nevertheless send a strong message to others that it doesn't believe that the other MLB teams were playing to their potential, and that it could do better."

To better understand the real risk and the slippery slope that we could be taken down, please read the entire article.  Decide for yourself and critically analyze anyone's talking points!

The Evolution of the US Healthcare System: A Process

There is a great outline of the history of the US Healthcare System starting with the 1900s from PBS.  I've been involved operationally with the evolution of our healthcare system since the late 1970s and really think we can't talk about reform until we have looked at where we have come from.  I've recommended the book Social Transformation of Medicine, but if you want a short overview at least look at the PBS timeline at http://www.pbs.org/healthcarecrisis/history.htm.

I think it is important to remind everyone that health insurance started with GM offering this as a benefit to attract employees in the 1920s.  Before that time, people paid cash, pigs, eggs, chickens, etc. as compensation for their healthcare services or received it for free from those with a calling. 

The US and sophistication of medical care and interventions grew and these efforts, like many others that followed were soon outgrown.  Finally, the government took some decisive action in 1965 with the Medicare and Medicaid legislation.  Since that time, we have continually worked to refined the way our healthcare is delivered and the mechanisms for covering the cost.  Once again, we find ourselves in the position of needing to improve the system and its processes and we have two choices.

a.  Continue to build upon the creative ideas that have made the quality and safety of our healthcare second to none.

b.  Tear down the system that has been built by employers, taxpayers, healthcare industry and multi-government guidance and investment by slowly allowing our legislators (the people late to the party) to move toward a single payor system that will create a monopoly and devastate our ability to make choices.

I recommend that we not throw out the good work of so many and that we find new and creative ways to address the current gaps -- the uninsured.  To be successful, we must address each of the environmental impacts upon the healthcare system and these include:

• over regulation (healthcare is the most overly regulated industry in the US)

• public education and understanding of the societal issues that impact the cost of healthcare (immigration, end-of-life care, lifestyle choices, etc.)

• promoting individual self-responsibility, self-control and investment in making choices to help reduce the costs of healthcare

• tort reform (to reduce unnecessary costs driven by fears of lawsuits)

• collaboration and transparency to ensure an effective and efficient healthcare system  

As a society we need to reprioritize the issues facing us and move forward in the process to improve and refine the healthcare system in the US.  I've been invited to join a panel of local physicians this evening to discuss healthcare reform and hope my local readers will attend so we can communicate and collaborate to identify solutions.   Let's get back to applying scientific methods to improve the healthcare system, not any one stakeholder's individual interests or politics. 

Think Plan-Do-Check-Act, Shewhart Cycle, or PDCA!

Coverage: 

Noozhawk

Is pork safe to eat?

The Novel H1N1 is also known as swine flu and this has caused some concern about whether pork is safe to eat.  Nothing that I've seen from any of the reputable sites says that a person can get the H1N1 influenza by eating pork.  My family and I have been eating pork and will continue.

Virologists do say the Novel H1N1 2009 virus MAY reemerge here in the fall and may be more virulent after circulating south of the equator.  And, this is the reason for the current planning that is taking place in communities and healthcare organizations around the country.

It is possible that a pig within U.S. borders may become infected with the Novel H1N1 virus.  If that should occur, experts, including USDA and the Centers for Disease Control and Prevention, unequivocally say this is not a food safety risk.  A person cannot contract the flu from eating pork, however, you would want to protect yourself from a sick pick and not go near their droppings.

To learn more about Novel H1N1go to: http://www.cdc.gov/h1n1flu/

Pandemic Planning and Job Action Sheets/Checklists

I'm now working on some pandemic planning and want to share a few items that look like they will really be helpful.  At the end, I'll also make a request for any of you who can help me with checklists and job action sheets.

The first is a monograph from the Joint Commission Providing a Safer Environment of Care for Healthcare Personnel and Patients from Influenza Vaccination.  It is 104 pages so the podcast might be of interest to those of you on the move.

The second item is the Pediatric Surge Guide brought to us by LA County Public Health.  It is really important that we are prepared for pediatric surges as we enter this coming flu season, since the risk exists and is significant.

The third and related item is an interactive surge training tool Surge World brought to us by Children's Hospital Los Angeles.

The fourth is National Strategic Plan for Emergency Department Outbreaks of H1N1 Influenza by the American College of Emergency Physicians.

Now for the request.... I'm looking for sample job action sheets or checklists for public health and their partners.  There is a great deal out their that addresses planning, but I'm operationalizing the plan and need specific tasks and items for those working with the coroner, vital stats, epidemology, public health, law enforcement, mortuaries, first responders/fire, etc.   Please send any samples or links and let me know if you need anything that I might find.

Evaluating the Overall Performance of Hospital Leaders

In a recent H&HN article, Paul Hoffman suggests Ten Questions for Hospital Leaders to see if they are addressing the right issues.  I'd like to take this a step further, because I believe evaluating hospital leadership goes farther. 

First, the question should be asked if the governing body is also aware of these questions and their answers.  An effective leader not only has great answers or examples to these questions, but has also educated his/her governing body members and they have an awareness of these issues.

And, second, employees and the medical staff should also have knowledge of the answers to these questions.  It is one thing to have a policy that addresses inappropriate behavior and completely another to have a surgical nurse be able to explain the policy.

These questions are also a good self-assessment by leaders and some would be good interview questions for those organizations making a change.  My favorite of the 10 questions: 

What steps are being taken to: (a) maximize the recruitment and retention of the best qualified staff (b) minimize compassion fatigue, (c) reduce the incidence of professional tension and (d) ensure high staff morale?

My second favorite question, because it goes to the heart of planning for the IT investments that will be made over the next few years is:

What objective criteria have been developed to assess program proposals, acquisition of new technology and similar investments?  How have audits of previous investments improved the assessment process?

EHR Saving Lives

Now, here is some good news for those of us working to move the adoption of EHRs along.  A Kaiser study found EHRs were at the core of saving cardiac patient lives.

The two-year randomized trial of 421 patients found that patients discharged from the more intensive portion of the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders.  Other achieved results, include:

• Patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program;
• The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and
• The number of patients screened for cholesterol went from 55 percent to 97 percent.

The most exciting finding from the study, after saving lives, was that the outcome came by Kaiser providing a more efficient, yet equally effective, option to help guide patients.  While the clinical measures are important, so are the cost (resource) measures.  Saving money will lead to improved access for all!

If you are aware of other studies that have measured outcomes from implementation of EHRs, lets add links to the post and start a listing.

Smartphone Survey Results

I've been following a survey of smartphone users and the results are in!  Now I'm an administrator, so I'm not too surprised by the fact that Blackberrys lead the way among my peers.  I loved mine and may go back to one when I have a chance to explore my options. I'm also not too surprised by physicians using the iPhone, since I've seen them in action.

Apple's iPhone appears to be the leading contender among all and maybe the dominant smartphone in the market.  However, new technology is introduced everyday.

Now, many of our healthcare respondents thought that no smartphone would become a necessity in the medical world and I think I need to disagree with this belief.  From my research (reading the research of others) I think that smart phones are becoming a necessity in the world of physicians and the use of this tool will continue to grow.  It gives physicians some freedom to have a real life and still be available for their patients.

 

Yes, it is all about the apps and my interest is health information exchange makes me happy to see the graph of current uses.

 

Visit the rest of the results at Software Advice and let me know what you think.  Especially about e-prescribing (my crystal ball says this will grow - hopefully soon). 

 

Wisely Using the Injection of Cash for HIEs

It was a pleasure to be interviewed by the writer of For the Records HIEs Seek a Cash Injection, because it provided me an opportunity to reach a broader audience and hopefully motivate a few hospital administrators and communities to start their planning process now, it they haven't already done so.  Great leaders aren't the ones "wondering what happened"  they are the ones out front "making things happen". 

As I've stated before, lets get it right!