Christina's Considerations

TeleICU Lowers Mortality Rates and Length of Stay

I love reporting good news!  Today I share the results of a meta-analysis looking reported in the March 28 issue of Archives of Internal Medicine.  Researchers looked at the use of telemedicine and found reduced mortality rates (20%) and shortened average length of stay (1.26 days) in the ICU.

My favorite part is where the editorial encourages physicians to revisit the goals of ICU telemedicine itself -- not just seeing it as an option for patient safety but rather as an effectiveness tool if it proved to be more effective.

Healthcare's Most Wanted Fraudsters

Some of our rising healthcare costs are due to fraud -- individuals who steal from federal healthcare programs.  This contributes to the mess we are in today and I'd like to see it stopped.  On top of this, while doing some research for a new article, I learned that malicious and criminal attacks of sensitive healthcare information (personal and financial) are on the rise and this will cost us even more.

HHS is working to focus public attention on this issue and has created it's own "most wanted" poster of healthcare fugitives.  Those listed on the site are reported to have cost taxpayers more than $124 million in fraud.

See the HHS OIG Fugitives now and lets see how fast we can fill up the captured page!

OIG Hotline Number   1-800-447-8477 (1-800-HHS-TIPS)

Other Contact Information

Preparing Hospitals for Disasters

One of my current roles is to prepare and facilitate emergency/disaster exercises with hospitals and partners.  A great resource for anyone responsible for designing, developing, conducting, and evaluating a hospital exercise are the appendices developed by the California Hospital Association .  Exercise components, tools, resources, and coordinating accreditation, grant and regulatory compliance is included.

Learning from Children

As a parent (of three), I recognize that you can learn from children.  But today, I'll write about how we can learn from pediatric hospitals.

The current issue of Healthcare Executive has an article by a hospital leader on ways adult hospitals can learn from pediatric hospitals.  His second strategy addresses patients learning from and comforting one an other -- and presents social media as one tool.  I'd like to suggest that pediatric hospitals are leaders in use of social media as evidence by the ease of me finding, and the quality of, examples during the research period for my book.  Just look at my list of best practices and you can see for yourself the strong showing by children's hospitals.

If you don't believe me, then consider the suggestion of an article on Facebook use among hospitals.  The referenced study found that, in general, hospitals are not fully taking advantage of Facebook.  But, children's hospitals appear to be the clear leaders in the use of Facebook.  This isn't a surprise to me when we consider that youth were the early heavy users of Facebook and children's hospitals have been simply connecting where their target audience is already communicating.

To the study authors, I say that the reason adult facilities are lagging behind pediatric hospitals is due to a variety of reasons, including:

• So many other pressing matters/competing interests
• Fears related to reputation management
• committing resources to social media

However, older adult use of Facebook is the fastest growing age segment and once adult hospitals realize this, their attention will turn to connecting with their target audience(s) on Facebook.  Sit tight...the tipping point is coming!

 

 

Addressing Care Delivery Challenges: Opportunities for Technology

On a recent flight, I read a wonderful article in HFMA's magazine on using technology to address care delivery challenges.  The case study of using eICU to help keep a rural hospital's unit open fit in nicely with my comments in the Mission Critical:  Telemedicine in the ICU article.  The hospital staff have two mobile workstations that can be moved to any of the ICU or two ER Trauma bays, as needed.  The technology is used for monitoring patients at night and it has contributed to reduced length of stay and improved outcomes.  More importantly, it helped the hospital recruit a new internist so that patients can obtain quality care in their own community.

The community-wide EHR and e-visit case studies were also timely.  But keep in mind, telemedicine's bottleneck and limited/non-existent broadband access in some communities.

The FCCs Rural Broadband Capacity Survey found the average download bandwidth at rural hospitals and clinics to be between 382 and 196, and that really isn't enough for HIE (of data available in EHRs) or downloading images and video.

 

Guidance for Healthcare Professionals Evaluating Travelers from Tsunami-Affected Areas

Travelers to tsunami-affected areas may return with a variety of physical concerns. Today, the CDC will host a conference call with a subject matter expert to discuss their interim guidance for clinicians evaluating travelers returning from Tsunami-Affected areas.  They will provide information for clinicians involved in planning for and responding to this type of emergency.  Related resouces include:

CDC Interim Guidance for Healthcare Professionals Evaluating Travelers Returning from Tsunami-Affected Areas

Radiation Emergencies Information for Clinicians

Radiation Emergency Medical Management – HHS/NLM

An archive of the call will be maintained (audio and transcript).

Empowering Patients with Transactional Tools

NCR got its start in banking, but healthcare is benefiting from their success as hospitals respond to the needs of ePatients and empower them to do more for themselves.  It is about satisfying customers with self-service and convenience and survey findings indicate consumers are most interested in the following:

• Booking an appointment online (54%)
• Securely receiving lab results online (54%)
• Seeing and managing personal health information on the Internet (43%)
• Receiving a text message notification if an appointment becomes available at short notice (32%)
• Paying outstanding balances online or via a mobile phone (31%)

Another study titled Mobile and Social Gain Ground in Wellness and Disease Management found that when mobile and social programs are available or offered by their employer or health plan, 44% of consumers had taken part.

Lastly, technology's like Intel's Health Guide offers consumers a touch-screen home monitoring device that helps patients measure vital signs, respond to questions specific to their condition and enables videoconferencing so clinicians can assess patients for signs and symptoms suggesting deterioration in their condition.

Where do I sign up?

My AirDream

If I were single again... I'd have to consider having Matthew renovate an Airstream trailer for me.  Or, I could set one up for me when the nest is empty and my hubby and I have more freedom to head into the great outdoors! 

Cool trailer!  See the LA Times article too!

Increasing Hospital Risks

There are a couple of increasing risks for hospital worthy of some attention.  The first is drug shortages. 

I most often think of drug shortage risks in disaster response planning and events, but there have also been times during my career where our hospital pharmacy has had a difficult time finding a sufficient amount of a particular drug.  If there is a rising trend for certain drugs then it should probably be incorporated into regular emergency management planning activities -- at least at the departmental level.  I really like the sample response plan provided and highly recommend Dubin Medical Inc, if you are having difficulty locating a medication or drug.

The second risk involves database hacking and it is one of the top 10 Health IT trends for 2011.  Basically, as the profit margins in the financial industry shrink, criminals are looking toward new sources of profitable data. Managing data security is already on a hospital's list of things-to-do, but this might be a new type of motivation and consideration.

Broadband Availability Map

The FCCs National Broadband Map is now available and allows for sorting and analyzing data by technology, provider, speed, and anchor institution.  Example reports drawn from this data include Broadband Availability in Urban vs. Rural Areas  and Areas with No Broadband Availability.  Also, notice the amount of white in the west.

If you are working on a health information exchange project, this could be useful information.  Especially, if it involves rural communities who face other HIT challenges.  Also, check out the National Broadband Plan.

 

HITECH: A Crazy Train

Iatric's HIMSS booth included the showing of their HITECH video of a hospital CIO's life to music of Ozzy Osbourn's Crazy Train.  It is a great combination! 

Localized Underpayment of Physicians by Medicare

It has been well known for years that Santa Barbara county physicians are underpaid by Medicare due to outdated reimbursement formulas, because we are classified as a rural area.  The high cost of living and a large senior population makes this an especially challenging situation.  While we are categorized as rural in this way, we also don't get the benefit of being reimbursed for telemedicine, because our population is too high. 

I think this is an example of where the public wants to see some consistency and common sense from the Centers for Medicare & Medicaid Services and other federal agencies.  The most recent case filed challenging Medicare's formulas for calculating reimbursment in the area will hopefully resolve this at last.

Hand Hygiene Monitoring in Hospitals

At my last hospital, we struggled to find effective and efficient ways of monitoring and managing hand washing compliance, because it can significantly reduce Hospital-Acquired Infections(HAIs).  But, the answer may now come from something I saw on the exhibit floor at HIMSS,

Ekahau has a really cool technology for all of my Environment of Care friends.  The Infection Control Solution uses wireless technology to track the location and staff interactions with patients and measures hand hygiene activity down to the individual caregiver.  This means supervisors can check to see if an employee or physician washed their hands after completing a patient encounter.  This information can then be used in job performance assessments.

 

I think most job descriptions (and the rules and regulations of medical staffs) include something along the lines of "complies with hospital policies".  If your policy then states that employees and medical staff members must wash their hands between patients then you are set for monitoring.

Let me know if you think this will be helpful or if you are already using this technology.

California's Model Statute and Plan for Telehealth

The Center for Connected Health Policy has released a model statute for California that recommends modernizing state telemedicine and workforce laws, to encourage more robust adoption of telehealth technologies.  The full report, Advancing California’s Leadership in Telehealth Policy:  A Telehealth Model Statute & Other Policy Recommendations,” makes 13 recommendations in four categories:
 

• Revisions to the state’s Telemedicine Development Act of 1996 (TDA), focusing primarily on financial incentives and informed consent;
• Recommendations to incorporate telehealth into state workforce law;
• Statutory recommendations to promote interoperability of technology and consumer education;
• Recommendations on increasing research and education efforts in telehealth technologies. 

Documents available for download include:

Telehealth Model Statute Full Report
Executive Summary
FAQ
Telehealth Case Studies

Once you read through this, leave a comment and let me know what you think!
 

Going Red for Heart Disease: Floyd Memorial Hospital

There is also a Floyd Memorial Hospital in Indiana and they use online video to engage audiences.  They and Floyd Medical Center in Georgia look like great places to work.

 

Hospital Responds to Criticisms Playing out in Social Media

A hospital in Canada has chosen to respond to misinformation about a young patient in both traditional and social media.  This is a great example of a hospital choosing when to respond, how and by whom.

Say a prayer for this child and his family!

Mobile and Social Technologies to Improve Health Outcomes

The Southern California Telemedicine Learning Center presented a great program titled "Using Mobile and Social Technologies to Improve Health Outcomes"   Dr. Keven Patrick reviewed a few intervention studies involving texting and social networking to help patients and their physicians measure, monitor and improve health outcomes.

Dr. Patrick is a researcher with the Center for Wireless & Population Health Systems focusing on how the health of individuals, families, communities, social networks, and populations can be improved through the creative use of wireless and networked technologies and ubiquitous computing.  They also study how to promote health and prevent disease and disability through systems-level interventions in clinical and community settings.  Their website includes an overview of a variety of really interesting projects.

If you would like to have a link to view the recorded program contact telemedicine@ucsd.edu.