Christina's Considerations

Physicians On Call

California Health Care Foundation explores emergency department coverage in their latest paper and presents opportunities for improvement that include the application of telehealth technologies (see page 14) and community call.  I was especially impressed with the creativity of some of the payment solutions being used by hospitals, such as, deferred compensation and favorable OR start times. The paper has several great ideas, so read California's patchwork approach to emergency department coverage.

If you go to New Orleans... go see the Mardi Gras!

My husband and son took a trip to New Orleans and last night took the advice of Professor Longhair and went to the Mardi Gras!  Hearing this song really makes me wish I were there too! 

HIMSS Store

The HIMSS Conference Bookstore had both of my books for sale and I guess Social Media in Healthcare did really well.  When I checked on Wednesday morning, I learned they were running out and had to order more the evening before. 

It is great the HIMSS attendees are interested in the topic of social media as evidence by book purchases and audience size at the Social Media Center.  In addition, for the first time, Meet the Bloggers was a formal educational session.

If you need a copy and want to support the work of HIMSS at the same time just visit their online bookstore.  And, don't forget to check out the online best practices.

I forgot to ask about the RHIO Guide, so I'll have to check after they all recover from such a long week.

Floyd Medical Center - Communicating Expectations

One of my readers thought I would be interested in how his hospital is educating and informing its staff on their new social media policy.  Developing a policy is easy, but finding a creative way to entertain while you are communicating your organizations expectations on social media takes a little more initiative and creativity. 

I say Floyd Medical Center "ROCKS!!" for having a social media policy and finding another social media tool (YouTube) to help them educate and really engage their staff.

 

Also check out their perioperative patient guide!

Car Crash & Death in Hospital Parking Garage

Security and emergency response issues are highlighted during the events surrounding a gentleman crashing his car in a hospital parking structure; and this presents an opportunity to revisit your policies with staff.

My impression is that this hospital staff responded appropriately.  They were correct to call 911 first, and then to assess the activities of the ER and identify and send staff when it was determined that they could reassign and release the employee.  It may seem to law enforcement that someone should have immediately responded by following him out to the accident scene, however, the staff first have a duty to the patients in the ER and hospital.  Once it is deemed safe to do so, then they can send someone out.

I think this is a great case study for discussion!

 

Children & Telehealth

A Pacific Rim Department of Defense study found that telehealth cuts pediatric costs; reducing spending by as much as $750,000 annually.  Not surprisingly, reductions were most notable in remote areas where pediatric specialists are not available.  The also found that:

• The online consult resulted in a change in diagnosis or treatment of the patient in 74% of the time
• Physicians resolved the patient's primary problem 60% of the time
• The telehealth consult kept patients from having to be transferred to larger facilities 43% of the time

One example of where I can really see it being beneficial is with stroke, which is increasingly being recognized in children.  But, diagnosis and management can be difficult, so telehealth presents an excellent opportunity to connect children with needed pediatric neurologists.

And, as a parent of three children I wish school telehealth was broadly available.  AHRQ reports that it reduces those pesky visits to the ER by 20% and helps parents reduce lost time from work (and income).  Unfortunately, it also means the kids miss less school, too.  :)

Bloggers and Social Media Risk

I'm in Orlando this week for HIMSS and presenting later today at the Social Media Center on managing risks.  My slides were submitted in advance, but I do want to reference a really great conversation related to ethics and risks that has been occurring on Medpedia over the last week (and include the link here.) 

The question raised in this conversation relates to medical and nursing students posting pictures of patients and/or their body parts on Facebook or other social media sites.  The examples provided were "in fun", but the question presented is also exploring where to draw the line.  Several doctors have already shared their views, so it is really worth the read if you are interested in the subject of social media and risks.

On Wednesday, I join the Meet the Bloggers panel to share my thoughts and considerations about blogging and the blogosphere. 

It looks like meaningful use will be the big topic of discussion and I look forward to catching up with some of my old RHIO/HIE friends.  I'm also looking forward to seeing how telehealth is presented and viewed by the attendees.

If you are here this week, come by one of my sessions and say "hello".

HIT Exchange Magazine

A new health information technology focused magazine will be released at HIMSS next week.  It will be interesting to see how HIT Exchange Magazine converges healthcare business with technology.  I'm impressed right from the start since they recognize healthcare as a business (profit, non-profit, government or otherwise).  Check out their editorial calendar and lets see how they do!

Hospital Ranking Sites and Resources

Hospitalicious has a list of hospital ranking sites and resources for the US.  These along with the data being made public by state agencies (CA Mortality, CA Surgical Procedure Costs, etc) will be useful as you conduct your own research.  Another good resource is the Dartmough Atlas of Healthcare.

CA Healthcare Workforce

Last weekend I participated in a web talkshow with college students interested in HIT careers and today my audience is high school.

High School Career Days are also a great time to make an impression upon the future healthcare workforce.  For example, I decided to go into hospital administration at the age of 17 and have never turned back.

So, I'm really pleased to have the opportunity to participate in the San Marcos HS Career Day  and to share my thoughts about careers and employment in healthcare.  I prepared a handout focused on Santa Barbara and California opportunities, but think it might be helpful to some of my readers, as well.

Jobs in the following have been identified as California's critical workforce needs:

• Nursing
• Allied Health- Imaging, Pharmacy, Lab
• Public Health
• Home Health
• Long Term Care
• Primary care and other specialties (physicians and other practitioners)
• Community Health
• Oral Health
• Mental Health
• Senior leaders and middle managers in all sectors
• Life Sciences
• Health Information Technology (HIT)

However, I'd like to suggest adding a few careers based upon my experience with recruiting and hiring hospital staff.

• Geriatrics
• Therapists – Speech/Language, Physical, Occupational
• Medical Coding
• Medical Interpreters
• Biomedical Technicians

I would also recommend that any healthcare professional take advantage of training or educational opportunities in health information technology, since this will be such a big part of our future workplace environments.  If you are in the Santa Barbara area visit the SBCC HIT Workforce Training Program.

One new overview resource is the California Hospital Association Report on the Allied Health Workforce.

Making a Virtual Connection

Just saw the digital copy of For The Record Magazine and the article on making virtual connections with social media.

Hospital Evacuation: It can happen!

For the last couple of years, I've been planning for hospital evacuations -- something that is really difficult to think will really happen.  However, it can and does, so it is better to be prepared.

The current issue of the NFPA Journal includes the story of one hospital and some lessons learned and it is titled Unthinkable.  I'd like to reinforce the importance of two of the lessons they learned:

1. department-specific disaster plans
2. training for emergency communications

If you want some help getting started or think a review of your current plan could be helpful, just let me know.

Health in a Networked Life

Markle identified some interesting social and cultural findings in their survey Health in a Networked Life.  They include:

• Many doctors and patients surveyed believe key information is lost in their health care conversations.
• A majority of the doctors surveyed indicate a preference for modern communications tools. Three in four doctors say they want to be able to share patient information with other professionals electronically. Roughly half prefer computer-based means to share information with their patients.
• A clear majority of the public and doctors agree that patients ought to be able to download their personal health information online and share information electronically with doctors.
• Roughly 80 percent majorities of both the public and doctors agree it is important to require participating hospitals and doctors to share information to better coordinate care, cut unnecessary costs, and reduce medical errors.
• Majorities of both groups also agree on the importance of measuring progress and setting goals for improving the nation’s health in chronic problems such as heart disease, asthma, diabetes, and obesity.
• Roughly 4 in 5 of both groups express the importance of privacy protections as a requirement to ensure that public investment in health IT will be well spent.
• The public and doctors overwhelmingly support privacy-protective practices, such as letting people see who has accessed their records, notifying people affected by information breaches, and giving people mechanisms to exercise choice and request corrections.
• The public and doctors are largely unfamiliar with the details of the new health IT incentives, suggesting that education and outreach will be vital to the success of the program.

 
Study overview      Survey findings

Telehealth Technology Assessment Center

I needed to share a link to the Telehealth Technology Assessment Center site this week and was reminded of the great work they have been doing.  Some of my blog readers/visitors will find value in the toolkits focused on telemedicine and remote monitoring technologies.  The five released in 2010 are:

1. Digital Cameras
2. Desktop Video Applications (the product comparison is priceless)
3. Electronic Stethoscopes
4. Patient Exam Cameras
5. Technology Assessment 101

In 2011, you can expect to see a full evaluation of home health products (peripherals, units, and reviewing platforms), expansion of video conferencing assessments to include additional VTC components, and assessments of other devices, such as vital signs monitors, various scopes, or possibly additional imaging devices.

Lower Door-to-Needle Times for Acute Stroke Show Better Clinical Outcomes

Gregg C. Fonarow, M.D., professor of cardiovascular medicine at the University of California-Los Angeles is lead author of the Timeliness of tPA Therapy in Acute Ischemic Stroke:  Patient Characteristics, Hospital Factors and Outcomes Associated with Door-to-Needle Times within 60 Minutes  The study results, released today at the International Stroke Conference, examine the health delivery system and identify these key (to me) points:

• analysis demonstrates that a minority of patients treated with intravenous tPA receive this therapy within 60 minutes of arrival
• those... arriving during off-hours were particularly less likely to receive timely care
• hospitals with less experience in providing tPA to ischemic stroke patients were less likely to provide thrombolytic therapy within 60 minutes
• there was no evidence of worse in-hospital outcomes or increased bleeding complications from tPA for patients with door-to-needle times of less that 60 minutes compared with those with door-to-needle times of greater than 60 minutes
• in-hospital mortality was lower among those patients treated in a more timely fashion, even after extensive risk adjustment.   

This last point hits home, because hospital mortality rates for acute stroke are by far the highest in the State of California and my home region's rates are even worse.  I agree with the authors that these findings lend support for a targeted initiative to shorten door-to-needle times in acute ischemic stroke to maximize the clinical benefit and a few of us are attempting to do just this for our the tri-county region.  Stay tuned!

Listen to Dr. Fonarow's audio recording of his study results

Waiting Times for Key Diagnostic Tests in England

Transparancy is England's Department of Health sending out a tweet on their waiting times for key diagnostic tests.  Main findings include:

• The number of patients, for whom English commissioners are responsible, waiting over 6 weeks for any one of the 15 key diagnostics tests at the end of December 2010 was 10,100, an increase of 4,400 from November 2010, and 4,700 from December 2009.
• Of the patients waiting at the end of December 2010, 98.0% had been waiting under 6 weeks, compared to 98.9% in November 2010, and 98.9% in December 2009.

This is interesting data and I wonder how it compares to waiting times for key diagnostic tests here in the US.

Medicare Reimbursement Checklists

The Center for Telehealth & eHealth Law has released checklists for both the originating site and professional services based upon Medicare's 2011 changes in reimbursement.

ATA Recommends Six Fixes to Federal Policy Makers

Over the last few months the American Telemedicine Association has been working with the White House and federal agencies to identify specific changes that can be made to immediately improve the delivery of healthcare using telemedicine.  The six fixes identified are:

1.  Mandate telehealth as a covered service under federal health benefit plans

2. Increase federal coordination and impact on telemedicine

3. Clarify that Medicare "Physician Services" include proven telehealth services

4.  Pilot telehealth service and payment models for Medicare and Medicaid Patients

5.  Improve the process for CMS to add telehealth services under Medicare

6.  Support telehealth projects in the Administration's FY 2012 budget proposals

I think of these top six, I believe numbers 1, 3 (eliminating rural limitation) and 5 are real priorities.  What do you think?

 

Re-engineering the Hospital Discharge

I'm really interested in operational and clinical applications of social media to help hospital employees get the job done more efficiently and effectively.  I've been thinking about creating a list of examples on my blog and may start a new category/sub-category if I can get several examples.  So please share your examples with me.

Today, I'm sharing a link to a Boston University Medical School paper that was focused on reducing readmissions and establishing a transition program that works.  It uses a nurse Discharge Advocate to deliver patient education and take the patient through the After Hospital Care Plan.  In addition to having a tradition "live" nurse, patients also have the option of selecting a computerized avatar Discharge Advocate.  They have found that this second option:

• is particularly helpful to patients with low health literacy levels
• takes 51 minutes vs. 81 minutes for a live Discharge Advocate
• is preferred by 74% of patients
• encourages patients to be an active participant

 

Informal Learning and ACOs

Healthcare Leaders has a new report titled The Bridge to Accountable Care Organizations in a digital magazine format.  I does a nice job of orienting readers to what an ACO might look like, but it is also an example of how informal learning is impacting the workplace. 

It will take some thought by healthcare leaders to determine how they will leverage and promote informal learning opportunities, as well as, prepare for a new type of healthcare delivery system.  However, we have been down this path of change before .... think desktop computers, DRGs, managed care, etc.