Writings on my favorite professional topics - hospitals, workplace effectiveness, health information exchange and technology, telehealth, social media and healthy children and families.
The Joint Commission has a new statement on texting orders and I agree that just picking up your phone and texting in your next order is a rather risky activity.
Texting Orders
New | November 10, 2011
Is it acceptable for physicians and licensed independent practitioners (and other practitioners allowed to write orders) to text orders for patients to the hospital or other healthcare setting?
No it is not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting. This method provides no ability to verify the identity of the person sending the text and there is no way to keep the original message as validation of what is entered into the medical record.
However, I believe there should and will be some exceptions... cases where safeguards have been implemented to minimize the risk of HIPAA and other violations. For example, mHealth devices and apps that have demonstrated security, verification, documentation and audit functions will and should be acceptable for use in clinical settings. In addition, texting orders using secure messaging functions associated with an electronic health record (EHR) or personal health record (PHR) or on a hospital's Intranet will also be deemed appropriate.
It is where we are headed, so I hope Joint Commission is reading my post and will continue their analysis of this issue.
Instead, I decided to share a few tips on using social media during the conference and on the exhibit floor. Who knows, perhaps I would be responsible for someone sending their first tweet while attending RSNA11!
An excerpt of the post is below, but if you are a first time tweeter, you will want to review the entire post for the technical details at Tips for Using Social Media at RSNA 2011.
But, social media isn’t just about receiving information. It is also about joining in the conversation and networking. The acts of tweeting information and re-tweeting the tweets of others are just as important. Attendees should consider contributing to the #RSNA11 conversation by tweeting (up to 140 characters) their thoughts about exhibits and sessions or sharing the pearls of wisdom and new ideas that will come out of the week. Following the tweets of others who are participating in the meeting also gives you an opportunity to see other perspective or learn important information from sessions that you miss.
I like to use Twitter during conferences to help me keep track of those exceptional thoughts I always seem to have during educational sessions. In addition, I re-tweet the posts of others that offer value to my life and work. Once I return home, I just sign on to Twitter and go to my profile to review the bursts of new ideas and resources.
The latest issue of Telemedicine & eHealth includes an article that defines tele-intensive care. I have an interest in TeleICU and expect to see more widespread use as ACOs, medical homes and mobile health take hold in a new healthcare delivery system..
In the early days of RHIOs, ONC took a little time to establish a baseline understanding of some of the key terms and lexicon. So, it makes sense for telemedicine professionals to take time time to lay the ground work of a common language as we prepare to see an evolution in telemedicine and more widespread application to critical care situations.
Trying to summarize the article will take more time than having you read it. So, please read to learn the language and think about applications in your hospital environment. If you don't have access to the entire article, just let me know.
I finally let a cat out of the bag for the world to see for an article about women and maternity leave. It was a long time ago, but the feelings of being laid off after just returning from maternity leave remain in my memory.
My boss had made the comment about the few female CEOs in the company not having children at home almost two years earlier when I informed him I was getting married. I do believe his intention, as a mentor, was to make sure I recognized the reality of the day. I appreciated his concern.
I always had to fight against the current to accomplish my goals and just saw what lay ahead as one more challenge and another opportunity to prove my determination -- that I could "have my cake and eat it too." The reality was that my industry or company wasn't ready for me, or others like me.
At the time of my layoff, the environment was that we were having to re-invent the organization to survive through the tsunami of managed care. (This was at a time when managed care wanted new moms out of the hospital fast. I had been asked what time I planned to leave the hospital just seven hours after delivering my daughter. Legislation later required a more appropriate length of stay.)
I could understand the need to eliminate my position at thathospital, given the continual decline in census due to managed care. What I can't understand or even explain, is why my company, one I had worked for over many years, did not try in the slightest to find another position for me -- even in another area of the country. Maybe it was the fact that the "Columbian's" were in charge. Or perhaps, as my boss had cautioned, because I had just had a baby.
My boss continued to be a source of recommendations and referrals to opportunities, but the company let me down. Now that the "Columbians" are gone, it seems that perhaps the company has evolved. Hopefully, others haven't or won't share this experience.
After many moons, I finally had another opportunity to attend the California Society for Healthcare Attorneys Fall Forum. It was an especially wonderful opportunity for me to present to an audience of healthcare attorneys on the subject of managing the risks of social media. But, I also enjoyed the legal update from my fellow presenters.
Most of the really interesting bills are still in California's legislative process. A few interesting laws that did make it through this year include:
SB751 - Contracts between plans and hospitals prohibiting restrictions on providing plan enrollees information about cost range of procedures and quality.Quality information (ratings) must be risk adjusted and hospitals provided with the opportunity to review and respond. This will protect hospitals from those plans who don't do such a good job presenting information. For example, the hospital that received poor NICU ratings from a plan when they don't have a NICU!
AB1136 - Lift Teams - the staff do need to be trained and available, but they don't have to be standing around waiting to lift patients. Don't any employee representatives tell you they do!
AB 655 - Mandatory sharing of peer review information - It is limited to "peer review bodies" ie Medical Staffs, but ultimately the hospitals still have risks for liability. The medical staff coordinator and risk manager in me says this is confusing and a bit scary. Don't really see how this will ultimately produce any real benefit. In the end, it really isn't that mandatory!! Wonder what the Medial Staff and Hospital Liability Carriers think about this?
AB 415 - Telehealth - The physician does still need to be licensed in CA. (I hope they talk more about this at future events.)
Other legal issues to be aware of include:
Physician-Owned Distributors (and also other physician-owned businesses such as laser rentals, neurodiagnostic monitoring) - Under Congressional Scrutiny mostly focused on orthopedic and cardiac devices today. Potential for kickback issues (a little concern about Stark). Benefits of these arrangements is saving money, working with manufacturers to develop better quality products, promotes hospital-physician alignment on cost control. Cons, could lead to use of more expensive devices, potential for medical decision-making will be influenced by financial gain. Need to carefully analyze and plan for these relationships.
I also really enjoy the presentations on special issues related to ACOs under CA law and consent from the perspective of health reform and the Accountable Care Organizations. We were also all reminded of the importance of completing our Advanced Directives.
The review of ED call coverage compliance dilemmas and projections of what we can expect with "Open" ED call panels as health reform takes hold. Basically we will see these go away as the need for more skilled physicians/specialists are4 needed to care for the sicker ED patienst. Selection of physicians will be tied to the level of care needed (expertise) by the patient. Doctors who can't perform will still need their due process as the transition occurs. Think about the role of surgical intensivists in the new healthcare delivery system.
On a recent trip to Louisiana, I came across Roman Candy and brought some home. I also found this YouTube video that describes the history and type of taffy.
I can still see the Roman Candy man parked on the corner of West End Blvd. and Polk Ave. in Lakeview.
Modern Healthcare has a great article about applying social media in healthcare processes. Social-ized Medicine highlights the power of collaboration for immunization (with about.me/hscmvac) and ideas to reduce re-admissions and improve compliance with treatment plans.
There is a new list of 25 helpful sites for those thinking about entering the hospital administration field. I'm flattered to be included, but also want to share the list with any of my younger readers who may be exploring their career options.
I get a fair number of visitors to my blog who are students of healthcare professions or early careerists working they way up through leadership structures. And, given my background, many come from health administration programs. Since most of my posts are focused on effective hospital leadership and I truly believe in the importance of dealing with "The Good, The Bad and The Ugly", I am presenting an update on a case study from my own neighborhood.
Earlier this year Centers for Medicare and Medicaid Services (CMS) visited the County-operated locked psychiatric facilitiy in Santa Barbara and I shared my thoughts on the subject in a blog post The Value of Experienced Hospital Administrators. It has now come to light that CMS returned for a follow-up visit (as I would expect), which has resulted in a notice to initiatie proceedings to terminate the hospital's Medicare provider agreement on or before January 11, 2012.
This should be quite disturbing for the Santa Barbara County community. First, with the loss of Medicare funding, we can also expect Medicaid and private payor funding to cease. That means, the County will either need to continue operation of the facility without funding or find another facility to provide the services. In addition, the Psychiatric Health Facility (PHF) should also expect a visit from Licensing and Certification and possible action from the State. In other words, the microscope will be turned on and the heat turned up.
I've read the Statement of Deficiencies and Plan of Correction and just have to say that "time is of the essence" when responding to CMS or other statements of deficiencies. The notice states that termination of PHFs agreement with CMS may be avoided if, by October 27th, "credible documentation evidencing correction of the cited deficiencies that the hospital is otherwise in compliance with all Conditions of Participation applicable...". They also advise that "mere plans of future correction or evidence of progress toward correction will not be sufficient."
Unfortunately, the plan of correction proposes training, audits and other actions to be implemented in the future - specifically in and around November 10th -- exactly what CMS has said would be insufficient. So, what is CMS to do without losing the confidence of the public. Yes, that's right --terminate their agreement with the PHF. (Ugggghhhhhh!) It makes me ill just thinking about this!
The lessons in summary:
Expect to see CMS when you accept their reimbursement
Expect them to return (unannounced) to see that you have corrected the deficiencies they found and that there are no other deficiencies.
Take the Statement of Deficiencies seriously and make the needed corrections immediately... not plan to do so a month later.
There is good news on the subject of hospital acquired infections --new CDC data shows a significant decline in rates. For 2010, the CDC is reporting:
A 33 percent reduction in central line-associated bloodstream infections: a 35 percent reduction among critical care patients and a 26 percent reduction among non-critical care patients. A central line is a tube that is placed in a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become a freeway for germs to enter the body and cause serious bloodstream infections.
A 7 percent reduction in catheter-associated urinary tract infections throughout hospitals
A 10 percent reduction in surgical site infections
An 18 percent reduction in the number of people developing health care-associated invasive methicillin resistant Staphylococcus aureus (MRSA) infections
I received the following success story from Dan Bevels, Electronic Communications Specialist, at Floyd Medical Center in Rome, GA. He follows my blog and Twitter posts regularly and agreed to let me share the story with my readers. In his own words...
57% Increase in Facebook likes - 1,600% Increase in Facebook views - 3,750 YouTube views
In 2008 we came up with the idea to produce life size stand-ups of women striking various poses that suggest empowerment in the quest for breast health awareness and against breast cancer. These silhouettes or "paper dolls" as we fondly called them, were pink from the waist up with pants colored in our logo green. For three years these stand-ups were positioned around town in public areas and in front of generous businesses. They quickly became one of our most recognizable images and were seen as a seasonal landmark of sorts.
Their popularity was such that our community arts council approached us this year with the request of placing them beneath a set of arches that had been built in the median of the major thoroughfare as the symbolic entrance to our city. We agreed and had seven special silhouettes built for this purpose. These eight-foot tall dolls were colored in the same manner as the originals but, because they were part of an art project and were on government property, were not logo'd in any way.
Put in place at the beginning of breast cancer awareness month, the dolls stood as a silent symbol of solidarity with the women of northwest Georgia for three weeks. During that time we received nothing but positive comments about the project and its mission.
On October 20th, only eleven days before their removal, we received word from city officials that they had gotten a complaint that the dolls stood in the public right-of-way and should be removed. Despite having been put in place with the city's consent, we were told they must come down and were given only four hours to do so.
Suspecting that the complaint may have been competitive in nature (we practice in a very competitive market), our PR team gathered quickly and in less than fifteen minutes had a plan for how we would manage this from a communications standpoint. A plan born from the groundwork we had already laid.
We decided to use a grassroots approach that began with a message on our intranet, notifying our two thousand employees of the dolls removal. Additionally, we posted a message on our official hospital Facebook page and also on our breast center's Facebook page. We also produced a three-minute video package that showed the dolls removal and presented our response to the order, along with comments from a local breast health advocate which was placed on our YouTube page.
There was no official press release, only the steps mentioned. Within an hour the message went viral in our area and local media picked up the story. We began receiving interview requests from various media, including Atlanta's network affiliates.
A sign printing company we've partnered with before heard the story and offered to print yard signs supporting the cause, at no charge.
A local news radio station had Haley Walker, our PR Director, on their morning show for a twenty-minute interview, discussing the "Paper Dolls Controversy", breast health awareness and the overwhelming response we received. We requested, and were allowed to videotape the interview and also posted that to our YouTube and Facebook pages.
Within the first twenty-four hours, our Facebook likes increased by 57% and our number of Facebook views made a 1,600% jump. The original video was viewed over 3,700 times. Not exactly Justin Bieber type numbers, but still very significant for a 400-bed hospital in a small Georgia town. Those numbers compare favorably with what we’ve seen generated by other hospitals in our region and they don’t even include the number of times the radio interview was viewed.
In addition to the increases in social media traffic, the sign company handed out three thousand yard signs and another five hundred “Save the Dolls” t-shirts were given away, all stemming from a post on our intranet, a post on Facebook/Twitter and a video on YouTube. What a great proof of concept for our social media strategy!
The hoopla had died down somewhat now but we still receive comments from people telling us how this story turned and how lucky we were for it to have happened. We just smile and say thanks for the support. Silently, though, we remember that Ben Franklin said, “diligence is the mother of good luck”. We’ve been diligent in building our social media presence and this was just the fruit of that labor.
In addition to the lasting impact these acts of community support will have upon Floyd Medical Center, think of what this has done for increasing awareness for breast health!
Joint Commission surveyors have been evaluating compliance with the Patient-Centered Communication standards since January 1, 2011, but findings do not affect the accreditation decision. Instead, information collected staff during this pilot phase has been used to prepare the field for common implementation questions and concerns.
Great presentation from my friend in Arkansas at ATA's Fall Forum pulling some of my favorite topics together: telestroke, telemedicine and HIE. Please view and listen!
