Christina's Considerations

Social Media Center at HIMSS11

I'm going to Orlando next month to the big HIMSS Conference and want to share the HIMSS11 Blog post describing the Social Media Center; and some of the activities that will be taking place.  If you are planning to attend, let me know and we can meet up and talk about the blog and twitosphere, HIE or Telehealth!

 

 

Purple Gold (Tiger in Me)

I like this song!

Meaningful Use Stage 2: Longitudinal Health

I prepared something for the request for comments on Meaningful Use Stage 2 and thought I'd share it with my blog readers, as well.  If you are a clinician involved with longitudinal health, I'm especially interested in what you think.  Please share as a comment or send me an email to Christina {at} cthielst.com

Longitudinal Health is a care delivery system that allows for the continuous interaction between the care team and the patient using m-health technologies, which are also integrated with other health information technologies -- like an EHR.  It relies heavily upon remote monitoring and individualization.  There are pattern recognition applications to continually improve responses based on a patient's unique characteristics; and responses and interactions with the application and care team are additional data points.  Over time, the patient relationship is improved by tailoring messages and contact based on the individual responses.  Think of it as a virtual care team approach to chronic disease management.

If we look at this in the context of Meaningful Use Stage 2 and Improve Care Coordination. I think the following elements need to be included in a longitudinal care plan record.

• care team member
• diagnoses
• medications
• allergies
• goals of care
• data captured by remote monitoring device ( in and/or out-of range)
• interactions and interventions by care team members

Clinicians using these technologies may know of other elements that need to be captured in the record.

Thank you Dr. Joe Humphrey for sharing your knowledge with me!

World Hospitals and Health Services

The International Federation of Hospitals included the white paper I wrote last year for the Northwest Regional Telehealth Resource Center in their December issue of the journal World Hospitals and Health Services. 

We were really pleased to have the opportunity to share this with an international healthcare audience and hope countries around the world will find value in the ideas presented.

The goal: A single workflow for physicians

Last week I heard a physician describe how a single workflow is needed for EHR, telemedicine and health information exchange.  I appreciate him putting a simple term to what I've been thinking.

SoCal HIMSS 2nd Annual HIT Conference

The Academic Alliance of the HIMSS Southern California Chapter is hosting a Health IT Conference on March 9th from 7 am to 5 pm in Los Angeles.  I've been invited to participate in the Tele/Wireless panel to focus on the role of social media and telehealth applications.  

This is a wonderful opportunity for cross-collaboration and learning between faculty, students and health professionals, so I hope you will plan to attend if you are in the region.

Mental Illness in Our Society

Katie Couric addressed mental illness this week and I've heard about several people who were concerned about the behavior of Jared (including law enforcement) and took some form of action.  However, I haven't heard that anyone referred him for treatment or reached out to the mental health system in Arizona. 

We can't blame our healthcare system, if individuals we identify as having a mental illness are not referred for treatment.  As a society, we have to work together to get individuals into the mental health systems that exist today.  This will minimize the risk of what occurred in Tucson, and elsewhere. 

We also need to be prepared to fund mental health programs focused on prevention.  My guess is that treatment of Jared would have been less expensive than the cost we now face to respond to his behavior last weekend.  Wonderful medications exist -- let's get them to the people who need them!

 

 

Predictable Tragedy in Arizona

The Wall Street Journal had an opinion by Dr. E. Fuller Torrey  yesterday that is accurate in its claims of emptying state mental hospitals without having sufficient supports in place to care for those with serious mental illness.  In addition, the climate of the 90's also caused the closing of numerous private psychiatric units and hospitals, because of payment pressures and the stringent "medical necessity" criteria of payors.

As a result, we have a shortage of professionals and beds to treat these patients before their conditions worsen and they become a danger to themselves and/or others.

At Las Encinas Hospital in the early 90s we, unfortunately, admitted young people who were then newly diagnosed with serious mental illnesses.  It was a community approach and schools, the police, families, medical professionals and others referred these patients to us.  My wish is that all communities have a comprehensive approach to identifying those at-risk and referring them for the treatment they need to keep our society healthy.

The State of Social Media for Business

SmartBrief has a new research report  presenting data that can help you drive your organization's social media strategy.  I really liked theme 3:

It takes time for companies to incorporate social media effectively.

What could happen if you don't have a social media policy?

I don't know how he did it, but Nurse Phil at Health is Social , one of healthcare social media's royalty, went over the top with this vcast demonstrating what could happen if your hospital doesn't have a social media policy.  I'm just surprised he is blaming the ER nurses, when the lab and radiology techs could easily be the ones doing the tweeting. 

California Hospital Mortality (2008-2009)

It has been a while coming, so it was no surprise to see OSHPD release the mortality rates for California's Hospitals.  I think the risk-adjusted data is wonderful for benchmarking and improving performance. 

I do recommend that consumers and others be cautious about reviewing the data and consider other indicators as well as these when making judgements about a hospital and the care it provides.  Keep in mind that this data covers a limited number of conditions and procedures and that there may be other factors that contribute to the outcomes.

For example, I did notice the highest mortality by far (statewide) is acute stroke with 10.6 (2008) and 10.4 (2009).  This is really a reflection of the multiple issues and perhaps the reality of this stat will motivate  stakeholders to explore telestroke programs.  The problems include not enough stroke neurologists and patients getting to the hospital in time to receive treatment (tPA) fast enough.  One patient in Utah who did have access to a telestroke program shares his story.

Follow these links to see the data for each hospital in 2009 and 2008 .

 

How 'bout them Tigers!

What an exciting Cotton Bowl!  It was a great 41 to 24 win for LSU!

Translated Disaster Preparedness Information

If you are looking for a resource for disaster preparedness health information in multiple languages, you might try looking at what Health Information Translations has available.

End of Life Care: Debating Reimbursement for Important Conversations

There is a huge debate among politicians about whether CMS should reimburse physicians for discussing end-of life issues with their patients.  As you can imagine, these are serious conversations and they take a little planning and time.

I have something to say on this subject and will throw my voice into the debate.  I've worked in hospitals and healthcare for over thirty years and watched end-of-life processes play out in my own family with a great-grandparent, four grandparents and a few great aunts and uncles.  My wonderful father-in-law would be 106 if he were alive today and we just celebrated my mother-in-law's 97th birthday.

I've seen the impact that hospice, palliative care, advance directives, Do-Not-Resuscitate (DNR) orders and thoughtful consideration of treatment options can have on individuals and their caregiver and I've written previously on palliative care programs  and ethical issues related to end of life care. 

I also posted on a wonderful paper written by a physician addressing societal issues impacting our ability to die in real peace.  As Dr. Gawande states in his New Yorker Article, "modern medicine is good at staving off death with aggressive interventions - and bad at knowing when to focus, instead, on improving the days that terminal patients have left."  This is in part a result of our payment system -- we provide incentives for our doctors to use expensive treatments and procedures, but nothing for those who want to have a conversation with their patient about what they want from their end of life care.

There is no one response to end-of-life care and the dying process for an individual, except for the fact that death will ultimately come one day.  Too often fear, lack of information and emotional responses are in the driver seat and this is why we see so much of CMS' budget being invested in the final days of life.  I for one feel that there is room for improvement and would prefer to see some of this money invested in healthcare earlier in a person's life and to help patients and families better prepare for the inevitable.

As I see it, we have two choices...

1. government or payor organizations manage these decisions for us (real death panels implemented because of the unsustainable cost)
2. individuals with their physician (who is reimbursed for his/her time) manage these decisions  

Which do you prefer?