Christina's Considerations

ATA Launches the Hub

The American Telemedicine Association launched their social networking site with members only content areas and I think it is a great use of social media for an association to create communities of shared interests.  A recent post Social Networking: Aggregating Our Pluralistic Health System in Support of Health IT Adoption provides a vision along with my comment.

Integration Strategies and Health Reform Implementation Challenges

Healthcare Executives of Southern California is holding its annual meeting in conjunction with the 7^th Annual American Health Care Congress in Irvine, CA on December 7th & 8th.  The focus of the event will be Integration Strategies and Health Reform Implementation Challenges. 

Discounted rates are available for HCE members and you will also receive 6.0 ACHE Category I Credits.  For details or to register, go to http://www.worldcongress.com/ahcc. Or call Sara Alviani at (805) 650-1243 if you have questions or need assistance.

The line up of speakers is exceptional and I look forward to seeing you at the Annual HCE Breakfast Meeting!

Professionalism in the Use of Social Media

The American Medical Association has released its policy on social media and it fits nicely with what I've stated on the subject for anyone in healthcare.  With so many physicians using social media, I think AMA is taking a great leadership role on this matter.

I've included Intel's guidelines in my list of resources in the Behavior section of the book companion, because they have taken a comprehensive educational approach.  Not long ago, I also based a set of healthcare organization guidelines on these (giving credit to Intel).

So, if you haven't started to clarify your healthcare organization's expectations on use of social media, then there is no time like the present.

Ethical Decisions in Healthcare

As our healthcare delivery systems begins to experience one of the most massive transitions in history, I thought I'd remind myself and my peers about ACHE's Ethical Policy Statements.  Maybe it is feeling thankful for where I've been and for what I've received, or the reflection I experience each year around this time.  Whatever it is that is motivating this urge to share my ethical principles, I do so happily.

Pay close attention to those for:

• Ethical Issues Related to a Reduction in Force
• Decisions Near the End of Life
• Ethical Issues Related to Staff Shortages

  The first one relates to our current economic condition and the second two relate to decisions that will be made as we address reform to our healthcare delivery system.

Bobby Jindal: Governor of the Great State of Louisiana

I met Louisiana's Governor this morning and heard him speak at the Regan Ranch Center. One of the things he mentioned was that for 25 years, Louisiana's greatest export was its young people.  We moved in search of opportunity -- elsewhere.  I was among those and am really happy to hear that over the last three years, things have turned around a bit.

Louisiana has a storied political history, but it seems Bobby Jindah is making the changes that were overdue.  I'm really impressed with Governor Jindal and so pleased my family and friends overwhelmingly elected him to office.

I met him as he signed my copy of his new book -- Leadership and Crisis.  I shared that I was from Louisiana and even talked high schools with his wife.  Then later I read what he wrote in my book and it choke's me up a bit every time I think about it.

Christina - Come back to Louisiana!  Thanks!

Bobby Jindal

Sometimes, I wish I could.  It is nice to know I have a personal invitation from the Governor!  My mom will be so happy to hear about this!

BTW, he said he liked my fluer de lis (logo)!  I knew he would!!!!

 

The Innovator's Prescription:A Disruptive Solution for Health Care

I finally finished reading The Innovator's Prescription and really enjoyed the book, because it stimulated so many new ideas and ways of looking at our healthcare delivery system.  The multi-perspective views and comparisons to other industries and history throughout were great. The sections on regulation of access (pages 376-378) and nationalized heatlhcare systems (pages 399 - 402) were particularly interesting, but one line (page 400), in particular, really struck me:

"access to a waiting list is not access to health care"

I've included it here so my readers and I can keep it in mind as we improve our US healthcare delivery system for the future.

Everything PR: 100 Social Media Resources

For those of you who can't get enough on social media --- healthcare and beyond -- check out this list of 100 books at Everything PR.  I'm happy to have been included (see # 26).

Connected for Health

On my way up to Seattle this week I finally had a chance to read Connected for Health:  Using Electronic Health Records to Transform Care Delivery.  It is the story of Kaiser's EHR and should be read by anyone planning a large scale implementation.  However, it also has lessons learned that would be useful to anyone planning a healthcare organization transformation:  EHR or otherwise.

I really appreciated the attention to leadership and governance and their role in this pioneering project, as well as, their approach to reaching out and engaging key stakeholders.

The book does acknowledge that KP is both a payor and a provider.  My hope is that we can find new ways for providers and payors to partners, so they too can leverage resources and fully realize success for the benefit of the patient. 

 

New Social Media Resource for Public Health

The CDC is a social networking pioneer in the area of public health and metrics and that is why I included them as one of the best practices in Social Media in Healthcare.  They just released a Social MediaToolkit; which is perfect for their public health peers, but also of value to anyone absorbing as much advice as they can before they start down a social networking path.

So check it out and let me know what you think!

By the way, does your organization have its social media guidelines or policy in place yet?

Improving your ER’s Efficiency: with Telemedicine

Health Leaders had an article on improving the throughput of the hospital ER and their success key #4 is the role of video for emergencies.  This capability helps connect ER doctors to needed specialists when their patients need it most and it move patients through more quickly so the bed can be made available for the next waiting patient. This type of increased efficiency is ever more important as we prepare for the full impact of health reform.

At my last small rural hospital, I hated hearing that we had to transfer a patient out of our ER because they needed to have a specialist consult -- that we didn't have available.  It happened with both adults and children, and had we had video conferencing capabilities we could have probably eliminated 70% of these transfers.

I really believe we will start to experience an increase in telemedicine use in hospitals and one area that is ideal as a pilot for small hospitals is in their emergency room, unless your hospitalists need it first. 

Children's Medical Center in Dallas - a social media best practice

We are approaching the end of the year and the holidays, so I thought I'd share one of the best practices included in my book's online companion since it is relevant to the season. 

Children's hospitals play an important role in our healthcare delivery system and we need to be thankful for them.  There is no better way to recognize their role than by viewing the 24-hour photographic journey included in Children's Medical Center 2008 Annual Report.

Children’s Medical Center realizes that more and more consumers are seeking information online, and it wants to go where its consumers are and invest its resources more effectively. The hospital sees its involvement in social media as starting new conversations with consumers, and it recognizes that many will consume information, but not all will contribute.

Children’s started its weblog, Red Balloon, in April 2009 to reach a wider audience and has been using it to tell intriguing patient stories, provide pediatric health information on the most common questions, and provide comments from local experts on national health stories. A recent post included a video of a nurse practitioner being interviewed on the topic of sun safety from the hospital’s weekly TV segments. Another presented an amazing 24-hour photographic journey of a typical day at Children’s Medical Center pulled straight from the annual report.

Video and photographs capture the essence of Children's Medical Center and enhance each inspiring story and bit of health information provided to its community and new audiences.

 

Hospital Apps

One of my favorite smartphone apps, because it was the first one I knew that had been created by a hospital,  is Pillbox.  More and more hospitals are joining Community and Jewish Hospital to create their own apps to reach their wireless communities and patients. Vanderbilt Medical Center even has an app to help anesthesiologists monitor their patients.

Hospitals like Southern Regional Health System are also creating mobile friendly websites, so that users can access the same online information and resources while they are on the move.   Mobile visitors have increased from 2.5% of website traffic two months after they went live to 5% seven months later.

As we all get more familiar and comfortable with our smartphones we will use them more often to check for ER wait times and receive electronic information upon discharge (meaningful use criteria #'s 11 & 12).  Even a recent study evaluating patient experiences found that 28% of hospitals will include social media and networking sites in their strategy for online communication and interaction with ePatients.

This is where we are headed and it is exciting.  Who would have ever though we would be playing Pong on our TV one day and receiving our discharge instructions on our smartphone the next!

March 2011 Update:  I just learned about the Hospital Intel App that lets mobile users review hospital data from CMS on satisfaction, mortality and quality scores.  How handy, when you need healthcare when you are away from home and not sure which hospital to choose.

September 2011 Update:  How about the iTriage app to help consumers know when it is time to go to the hospital (or not).

Improvised Explosive Device Training and Exercise

The medical and health community having been busy preparing for the CA disaster training and exercise in an Improvised Explosive Device scenario.  The community-wide event is designed to test medical and health communications, medical surge and intelligence gathering and sharing preparedness/capabilities.  The hospitals, coroner, public health department and other partners will also use this event to test our newly updated mass fatality plans and preparedness. 

This week we participate in the tabletop exercise and finally on November 18th conclude with a full exercise event.  I'm sharing links to the training and preparation materials for those of you in other states who may be looking for resources to help with conducting your own exercise events.

Fierce Mobile Health on Telehealth

Fierce Mobile Health  has hit the scene as one of the top health technology news organizations.  I enjoy reading their publications and hearing about their events.  The next one will address regulatory and reimbursement issues in Washington DC.  I'm really sad to miss this due to a conflict, expecially since I'm recently completed some great conversations on regulatory issues and hope to finalize a presentation on reimbursement in Washington State today.  If you are able to attend, let me know what key ideas or pearls of wisdom come out of the event.  It will be greatly appreciated.

I should probably also mention their new ebook titled Connected Health:  Harnessing Telemedicine to Fcilitate Remote Diagnosis and Consultation.  I was happy to contribute to it and think you will find value in each chapter.  It is perfect for all of those doctors and administrators who have new iPads or Kindles, and have started thinking about whether they should incorporate telehealth technologies into their practice or hospital.

Protection from Social Media Risks

In my last post, I wore my risk manager hat, so I thought I’d continue on since social media in healthcare was still fairly new the last time I wore that hat.  However, once a risk manager, always a risk manager.

Patient confidentiality has always been important and over my career the scope  and the definition of a violation has been made more specific.  But, the basic premise is fairly straight forward whether we are talking about paper, talking in the elevator or adding a post to a social networking site.  

My advice in this world of electronic health information and social media is to consider the risk of each new application and to review your confidentiality and patient privacy policies to ensure that  they clearly reflect the expectations of your organization and proper behavior.

However, confidentiality and privacy in a hospital extends beyond personal health information and also includes confidential business information, such as human resource  matters, proprietary information, and medical staff activities.  Once again, the basic premise remains the same, but the policy’s language may need to be updated to clearly reflect the realities and technologies of our new world.

To review additional risks, see Avoid Social Media Poison

Medical Interpretation

I haven’t really been actively involved with the subject for the last couple of years,  but I feel strongly about the subject.  So I’m going to exercise my virtual voice, since this is one of my two main reasons for having a blog. 

My former patient advocate would be pleased with the news that there is now a certification program for Medical Interpreters.  I feel strongly that medical interpreters should receive specific training and be tested for competency (periodically), because not having a qualified interpreter is just as unsafe as not having one at all.

Our reality in a flat and mobile world is that we will always have patients with limited English proficiency, and to ensure that they receive the same level of quality and safe care as those of us who are proficient, we should have interpreters who are skilled and competent in translating conversations about medical conditions, symptoms, treatment options and consent.  Otherwise, we put our patients, providers and organizations at significant risk for misdiagnosis, errors, poor outcomes and adverse events.

If you would like to learn more visit the National Board of Certification for Medical Interpreters site.  Other really great resources on medical interpretation is the Safety Net Institute videos or publications and the  CA Healthcare Interpreting Association.

HCE SoCal Annual Meeting

Our Health Care Executives of Southern California   annual meeting is being health in conjunction with World Congress this year in Irvine.  If you are in southern California, join us and I'll see you there!

CMS Releases Final Rule: New Additions to Telehealth Coverage for 2011

News flash....CMS has just released its Final Rule for new additions to telehealth coverage for 2011 (see pages 486 to 526 for the major telehealth sections).  Highlights include:

• Individual and group kidney disease education (KDE) services (HCPCS codes G0420 and G0421, respectively);
• Individual and group diabetes self-management training (DSMT) services, with a minimum of 1 hour of in-person instruction to be furnished in the year following the initial DSMT service to ensure effective injection training (HCPCS codes G0108 and G0109, respectively);
• Group medical nutrition therapy (MNT) and health and behavior assessment and intervention (HBAI) services (CPT codes 97804, and 96153 and 96154, respectively);
• Subsequent hospital care services, with the limitation for the patient's admitting practitioner of one telehealth visit every 3 days (CPT codes 99231, 99232, and 99233); and
• Subsequent nursing facility care services, with the limitation for the patient's admitting practitioner of one telehealth visit every 30 days (CPT codes 99307, 99308, 99309, and 99310). 

CMS is also revising §410.78(b) and §414.65(a)(1) accordingly. Specifically, the agency is adding individual and group KDE services, individual and group DSMT services, group MNT services, group HBAI services, and subsequent hospital care and nursing facility care services to the list of telehealth services for which payment will be made at the applicable PFS payment amount for the service of the practitioner. CMS is continuing to specify that the physician visits required under §483.40(c) may not be furnished as telehealth services.

Another change includes an increase in the telehealth originating site facility fee to $24.10.

My suggestion, make sure your local/regional payors (Medicaid, private and others) are aware of CMS' new reimbursement policy andrequest that they consider making the same or similar changes.  You would be surprised at how many payors are still reimbursing at Medicare's rates from a few years ago!

 

Improving the Continuity of Care with Telehealth

Patient Safety and Quality Healthcare had a great article in their Sept/Oct issue on the role of telehealth in improving the continuity of care.  It basically comes down to extending the reach of clinicians beyond the traditional confines of the hospital walls and helping  clinicians take advantage of teachable moments – often when the patient is in their natural (home or remote) environment.

One of the great things about the article is the discussion about how telehealth (home and remote monitoring) will help hospitals lower costs, but also help them avoid the penalties for readmissions.  At this point, reimbursement is no longer a barrier – telehealth becomes a  cost of doing business.

Along these same lines, the New England Journal of Medicine also explored some of the forces that are driving health care home.  We seem to be going full circle and with the help of advances in technology, can now bring high quality preventative and routine care, as well as, interventions back into a patient’s home.  This is really good news for those who care or pay for those with chronic diseases or at the end of life.   I can only imagine that the quality of life for these patients will also improve. 

So, if you haven’t already started thinking about how you will expand the reach of your organization and creating virtual walls, then there is no time like the present to get started.