Christina's Considerations

4 Best Types of Apps for Hospital Use

Great HealthcareIT News article with advice from your's truly!  What are my top 4?

1. Those that free providers from offices or workstations

2. Those that offer access to lab results and medical imaging.

3. Those that convert a smartphone into a medical device.

4. Those that offer practice management. 

My prior posts on hospital apps include FDA Guidance on Mobile Health Apps and Hospital Apps. 

Here is great news on the FDA approval of one of my favorites, Calgary Scientific's diagnostic quality imaging app.  And, it is great for telestroke.

End-of-Life Discussions Do Not Affect Survival Rates

Discussing and documenting patients’ preferences for care at the end of life does not cause them any harm, contrary to recent claims. A new study published today in the Journal of Hospital Medicine found that patients who talk with their physicians about end-of-life care and have an advance directive in their medical record have similar survival rates as patients who do not have these discussions and documents.

The study included 356 patients admitted at three different hospitals who had low or medium risks of dying within one year. Patients were followed from 2003 to 2009. During the study, there were no differences in survival for patients who had an end-of-life discussion and those who had not; there also were no survival differences for those who had a living will in their medical record and those who did not.

“Our findings are reassuring. They support health care providers, who can initiate these discussions, and policy makers, who seek to reimburse these time consuming discussions,” said lead researcher Stacy M. Fischer, MD of the University of Colorado School of Medicine. “Most importantly, our findings are reassuring for patients and families who desire these discussions with their health care providers.”

“The term ‘death panels’ has sparked considerable controversy recently. It has undermined the efforts of clinicians who provide end-of-life care by scaring patients into thinking that their lives may be cut short for their families’ or society's best interest,” added Fischer. “We hope our study provides data to help inform the national debate about advance directives for key stakeholders; health care providers, policy makers, and patients and families.”

For more on this topic, including the discussion of reimbursement read my January post.

Tag Clouds

I've been wanting to create a Tag Cloud and finally had some time. The one below is of my May/June article for Healthcare Executive magazine. Visit http://tagcrowd.com/ to create your own Tag Cloud!

access active application apps blogs build care collaborate community conditions consumers customers decisions disease education engage enhance epatients execute families ferguson general health healthcare help hospital information internet media medical messages needs networking offer online opportunities organizations patients plans project provide sites social support technologies tools traditional used users virtual

created at TagCrowd.com

How To: Set up Office 365 with Direct Project

Sean at the Family Health Guy has a great post on setting up Office 365 with ONC's Direct Project.  I believe this will take us far and it is a wonderful opportunity for small, independent and/or rural providers to particiapte in health information exchange activities in their community or region.  It also makes for a great starting point to get some HIE projects started down the path of working out those ever so important relationships.

Social Media in Disasters

September is Disaster Preparedness Month so I'm especially happy to share the new Congressional Research Service report titled Social Media and Disasters: Current Uses, Future Options, and Policy Considerations.  It isn't limited to healthcare, but the information is still relevant.

They see social media it being used in disasters in two broad categories - passively to disseminate info and receive feedback and systematically as an emergency management tool. The latter goes further than the former by:

• using the medium to conduct emergency communications and issue warnings
• using social media to receive victim requests for assistance
• monitoring user activities and postings to establish situational awareness 
• using uploaded images to create damage estimates, etc.

As with everything, there are risks.  My recommendation is to trust who you follow, confirm information whenever possible and pay close attention to details of the tweet, such as, the time sent, if it is a re-tweet and the original sender.

A new Modern Healthcare article on Staying Connected may also be helpful.

I encourage all of my readers to make a plan and be prepared at home and work.  Visit the Ready.Gov site for helpful information and resources!

 

Where Good Ideas Come From

Innovation => Ideas:  evolve, incubate, hunch, collision, mingle, swap, combine, borrow, connect.... Chance favors the connected mind!

 

ICD 10 Transition Guide

CMS has published an ICD-10 Transition Guide to assist providers before the October 2013 due date.  The new code sets for electronic health transactions include an increase in codes from 17,000 to 155,000 and there are expanded data fields.

My key recommendations to providers include:

•  Identify all systems that accept/transmit diagnosis and procedure codes
• Ensure software is validate and capable of handling the new codes.  This includes software for coding, billing, scrubbers (claim editing), denial, audit and department specific (lab, pharmacy, radiology, research, etc).
• Don't minimize the importance of training

I also recommend that healthcare leaders consider how all of this new data can be used to support their planning processes.

Community Health Needs Assessments

The Health Care Reform Legislation (Patient Protection and Affordable Care Act) requires non-profit hospitals to perform a community health needs assessment every three years and adopt an implementation strategy to meet the outstanding community health needs identified in the assessment as a condition of maintaining the institution’s federal tax exemption.  The requirement is effective March 24, 2012. 

I was recently reminded of a community health needs assessment I completed with the Thai Community Development Center in East Hollywood in 2004.  So, I share the results from this survey and analysis and hope that it will help a few hospitals, especially if they have significant Thai populations.  

It is also always a pleasure to introduce new people to the important work of the Thai Community Development Center.

Behind the Mask

This was a good week for me as it relates to reading -- I finished two books!

Behind the Mask: the Mystique of Surgery and the Surgeons who Perform Them  was written by a general surgeon and fellow blogger (Heard in the OR). It was a wonderful peak inside of a world that I've been fortunate enough to see firsthand.  However, Dr. Gelber uses this book to educate us lay people on the body and common surgical procedures.  He also shares stories and his perspective on a variety of issues. It helped me fill in some of the missing pieces in my operating room (OR) knowledge generated from years of talking to surgeons and those peaks into the OR during my rounds.

This book should be required reading for anyone in medical school, hospital administrators (especially those who work directly with surgeons) and anyone involved with setting policy related to reimbursement and payment for surgical procedures.  I also recommend it for the reading list of my fellow Baby Boomers who may one day soon be referred to a General Surgeon.

A few things from the book stand out for me and I share them below.

"Training, experience, insight, knowledge, and more than a touch of humility combine to create a surgeon."

"The truly great surgeon is never so arrogant as to believe that something can't be wrong."

"The human body is constructed in a remarkable way that keeps it running during the most trying situations."

I learned about the omentum - "...an organ that brings new blood supply to areas in need" and its important role as a "watchdog".

Dr. Gelber discusses the importance of talking with the patient to help the physician head in the right direction.

He reviews the role of surgery pre and post diagnosis of Sepsis and need for immediate and aggressive response.  As he states, "... more malpractice lawsuits are won due to inadequate treatment of a complication than for the actual complication."

He comments on the risk of not allowing nurses (especially those in critical care) to "think" and it highlights the need to update nursing licensure and scope of practice requirements, especially given the anticipated shortage of physicians and nursing professionals.  

He brings up the important issue of end-of-life and palliative procedures.

And,he shares his frustration with knotted patient gowns.  I wonder if he (and administrators) know gowns with snaps exist and they are ideal for surgical patients and helping the surgeon access the right area of the body without frustration? (I learned about these after the linen staff notified me of the high rate of riped gowns.)

Over the years, I've worked with some wonderful surgeons.  Some had a rough edge and others had a bit of an ego, but all were truly caring and dedicated professionals. This book has given me some new insight and knowledge to have more intelligent clinical conversations with surgeons and ensure that clinicians have what they need to care for our patients - today and in the future. 

Social Media Revolution 2011

One of my HIT Seminar students gave me a link to this video and it is worth watching, especially if you believe social media is a passing fad!

 

Hot Trend for Real Healthy Living

My neighbors and I have had to organize and attend to a desire by the County to up-zone in our semi-rural neighborhood.  There are several infrastructure issues we are presenting as arguments against any significant upzoning, but there are a couple of things that are worthy of a post here on my blog, as well.

The first is a Wall Street Journal article about a hot trend that is already our current reality -- An Apple Tree Grows in Surburbia.  The article explains how more and more people are returning to a more sustainable lifestyle, which includes a certain amount of local and home food production.  We see the the space and simplier life being healthier, but it is also part of my family disaster preparedness and response plan.

We have been told one reason for the desired increase in residential units in our neighborhood is a lack of sufficient workforce housing in close proximity to employers.  However, today's mobile technologies and the current trend toward flexible workplaces should actually reduce the pressure to up-zone properties in established residential neighborhoods. In fact, the President has an interest in workplace flexibility and has directed all federal agencies to create plans for increasing the number of flexiblework schedules and mobile and remote workers. He wants federal agencies to become models for other public and private businesses.

Technology has taken us far and will continue to help reduce the need for workers to perform their job functions only at a downtown office location (or in the expensive hospital space).  The book Managing a Mobile Workforce describes how not all people always have to be physically present at the employer's location to effectively perform and fulfill their responsibilities. It also reveals how productivity can actually be increased with flexible work arrangements. Think about how flexible work could help you limit or avoid the commute, pollution, cost, congestion, childcare issues and stress that comes along with it all.  

 

Coming back full circle, the First Lady is also promoting family gardens and more healthy foods to reduce our childhood obesity trend.  Why worry about finding space for a community garden when each property and family has room for its own garden? 

It is time we take a more comprehensive approach and explore the impact of flexible work solutions and benefits of space as we address the work and life housing needs of our community. 

 

HHS Updating Regulations to Recognize Changing Technology

HHS has released its plan for retrospective review of existing rules that may actually be interfering with the delivery of healthcare services.  This review is in response to Executive Order 13563, which is aimed at all federal agencies and the streamlined, effective, efficient regulatory framework to achieve economic growth, investment flows, job-creation, and competition.

While HHS’s systematic review of regulations will focus on the elimination of rules that are no longer justified or necessary, the review will also consider strengthening, complementing, or modernizing rules where necessary or appropriate—including, if relevant, undertaking new rulemaking.  Key sections include:

Updating Regulations to Recognize Changing Technology, including

• Use of Telemedicine to Increase Access
• Aligning the Electronic Health Record Incentive Program with Other Electronic Reporting Systems

Improving Pre-market Review for Medical Devices

Regulation of Medical Devices

And, changes to the existing Conditions of Participation for Hospitals will also be interesting to watch.

Social Media Toolkit for Telehealth Professionals and Programs

When my full-time role ended with the Northwest Regional Telehealth Resource Center(NRTRC), I began working with them to create a social media toolkit for telehealth and telemedicine organizations, networks and professionals.  The fruit of the effort has now been released and is available on the NRTRC site.  

It is fairly comprehensive, but let me know if you think anything was missed.

Social Media in Telehealth Toolkit

1. Slide Presentation
2. Webinar Recording
3. Social Media Checklist – Word Document
4. Sample Social Media Guidelines
5. Sample Social Media Policy – Word Document
6. Channel Specific Advice
7. Telehealth Social Media Resources
8. Telehealth Guide for Social Media
9. Social Media Planning Worksheet – Word Document

As a little lagniappe, you will also see the digital retinopathy/teleopthalmology toolkit.

CTN Announces Model Communities and Training Resource

The California Telehealth Network recently announced their Model eHealth Communities, but also made an eHealth Broadband Adoption Training Program available.  It looks like a good resource for healthcare employee training.

Healthcare Online Trends

HealthLeaders has some interesting stats related to online trends of healthcare consumers.  This is greatly impacted by whether one's provider has the functionality desired on their site.  But, it is a sign that we are moving in the right direction.

Increased Prevalence of Stroke Hospitalizations Seen in Teens and Young Adults

Rising trends in risk factors and comorbidities are associated with the increase in stroke hospitalizations of teens and young adults.  For those in communities served by telestroke networks, it is important to keep this population in mind.

Ischemic stroke hospitalization rates in adolescents and young adults aged 15 to 44 increased up to 37% between 1995 and 2008 according to a study conducted by researchers at the Centers for Disease Control and Prevention (CDC). The findings available today in Annals of Neurology, a journal of the American Neurological Association and the Child Neurology Society, report an increase in the prevalence of hypertension, diabetes, obesity, lipid disorders, and tobacco use among this age group during the 14-year study period.

The American Heart Association states that stroke is the third leading cause of death in the U.S. and 87% of all cases are attributed to ischemic stroke, in which blood flow to the brain is blocked by blood clots or build-up of fatty deposits called plaque (atherosclerosis) inside blood vessels. Prior studies report stroke in adolescents and young adults accounts for 5% to 10% of all stroke incidences, and is one of the top 10 causes of childhood death.

CDC researchers used hospital discharge data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to identify patients hospitalized for ischemic stroke. Stroke risk factors and comorbidities among those hospitalized with stroke were also analyzed. “We identified significant increasing trends in ischemic stroke hospitalizations among adolescents and young adults,” said Mary George, M.D., M.S.P.H., lead author of the study and a medical officer with CDC's Division for Heart Disease and Stroke Prevention. “Our results from national surveillance data accentuate the need for public health initiatives to reduce the prevalence of risk factors for stroke among adolescents and young adults.”

Of the patients hospitalized for ischemic stroke, the study found that nearly one in three patients aged 15 to 34 years and over half aged 35 to 44 years were also diagnosed with hypertension. One-fourth of patients aged 35 to 44 years also had diabetes. One in four females aged 15 to 34, one in three females aged 35 to 44, and one in three males aged 15 to 44 were tobacco users. Other common co-existing conditions included obesity and lipid disorders.

The authors advised that adolescents, their guardians, and young adults can help avoid stroke by preventing and controlling hypertension, diabetes, and cholesterol; eating plenty of fresh fruits and vegetables and foods low in sodium and saturated fat; maintaining a healthy weight; engaging in regular physical activity; and not smoking.

CDC is working with public- and private-sector partners at the national, state, and local levels to educate Americans about the risk factors, health effects, and prevention measures of stroke. The agency is also enhancing the monitoring of stroke causes, associated conditions, and hospitalizations, as well as expanding the scientific literature on these topics.

 

 

Emergency Water Supply Planning

Preparations for the CA Statewide Medical Health Exercise are underway and today includes an American Water Works Association (AWWA)  web program on Planning for an Emergency Drinking Water Supply and Emergency Water Supply Planning for Hospitals and Health Care Facilities.   If you missed it the presentation slides are available for downloading.

A guide is also available at  Emergency Water Supply Planning for Hospitals and Health Care Facilities and there are resources on the CDC's healthy water site.

Also, since we are on the subject of disaster planning some of my readers may be interested in Carl Taylor's “Random To Do To List For Hurricane Irene”.  Carl lives and works in Alabama and shares his wisdom with those on the East Coast.