Christina's Considerations

New Health IT Toolkit for Rural Providers

A new online toolkit will serve as a pilot program for providing health information technology (HIT) resources to rural health care providers. The toolkit was developed by the Rural Assistance Center and the National Rural Health Resource Center and is designed to help rural providers find resources for HIT, electronic health records (EHR), meaningful use and related topics.

The toolkit provides guidance with planning, setup, implementaiton and operation of a HIT infrastructure, as well as, information on training programs, funding support and management expertise.  Using the toolkit, rural communities will be able to:

• Address challenges in finding capital funding
• Provide support to community colleges to enhance training programs
• Stay informed about legislation affecting EHRs
• Leverage multiple federal resources for project development

Terry Hill, executive director of the National Rural Health Resource Center, emphasizes, “A lot of rural providers need guidance on putting an HIT system in place. This toolkit gives them a starting point and can help them get through the entire implementation process.”

 

Patient Safety Toolkits from AHRQ

The Agency for Healthcare Research and Quality (AHRQ) has sets of toolkits designed to help health care institutions and clinicians provide—and consumers receive—safe, quality health care at various points in the health care process—in the hospital, in the emergency department, in the intensive care unit, in the pharmacy, and when being discharged from one setting to another.

The 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program and include multidisciplinary evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings. 

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Toolkits by Setting Type

Hospital — General 
Emergency Departments 
Hospital Care Units 
Outpatient Settings 
Consumer/Patient Care

Hospital—General – These toolkits contain evidence-based resources to help inpatient facilities improve performance around some of the most common and most serious patient safety problems faced by hospitals today.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients
• Patient Multidisciplinary Training for Medication Reconciliation
• Implementing a Program of Patient Safety in Small Rural Hospitals ;
• Preventing Venous Thromboembolisms in the Hospital
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia
• Reducing Discrepancies in Medication Histories and Orders at Handoffs
• Testing the Re-Engineered Hospital Discharge (One of my favorites- see Louise)
• Using Military Simulation to Improve Rural Obstetric Safety

Emergency Departments – These toolkits contain resources to help hospitals apply evidence-based safe practices in the Emergency Department (ED) to improve patient flow, implement a multidisciplinary simulation-based safety curriculum, and improve medication safety by implementing a formal ED pharmacist program.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Patient Flow in the Emergency Department
• A Simulation-Based Safety Curriculum in a Children's Hospital Emergency Department

Hospital Care Units – These toolkits contain resources to help hospitals apply evidence-based safe practices.

• Implementing Reduced Work Hours to Improve Patient Safety
• Improving Patient Safety Through Enhanced Provider Communication
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia

Outpatient Settings – These toolkits contain resources to help facilities address outpatient medication safety by applying evidence-based safe practices.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Safety in Clinics for Patients 55 and Older 
  Improving Warfarin Management
• Patient Multidisciplinary Training for Medication Reconciliation
• Testing the Re-Engineered Hospital Discharge

Consumer/Patient Care – These toolkits contain resources to help facilities educate consumers in medication safety and post-hospital care.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Improving Medication Safety in Clinics for Patients 55 and Older
• Improving Warfarin Management
• Testing the Re-Engineered Hospital Discharge
• Using Military Simulation to Improve Rural Obstetric Safety 

Additional toolkits may be added as they are developed and will be found at http://www.ahrq.gov/qual/pips/

 

 

The Patient's Checklist

I've always promoted self and family advocacy in healthcare situations.  As an administrator, I strive to create and environment for the patient to get the best and safest care possible.  However, the healthcare system is heavily dependent upon humans and mistakes and errors happen.

A new book, The Patient's Checklist, provides guidance to healthcare consumers and family members on just how to go about the process of ensuring that you are getting the best and safest hospital care possible. It also includes some basic checklists that can help you stay organized if you don't have access to a personal health record.The checklists include:

1. Before You Go: Tips to be better informed, prepared, proactive.
2. What to Bring: Practical (and personal) items to bring to help you maintain your humanity and sanity in the impersonal and chaotic world of a hospital.
3. During Your Stay: Tips to both increase your comfort during a hospital stay and partner more effectively with your care team.
4. Master Medication List: A user-friendly log to track all prescribed medications during your hospital stay.
5. Daily Medication Log: A daily log to help ensure that for any medication given, it’s the right drug, the right dose, at the right time—and that it is meant for you!
6. Daily Journal:  A brief but important way to chronicle each day of your hospitalization.
7. Discharge Plan: Tips to begin planning for your discharge now in anticipation of the complexities of home care.
8. Insurance: Tips to navigate our overly complicated insurance system.
9. Doctor Contacts: How to keep an organized list of all your doctors.
10. Family & Friends Contacts List: A way to consolidate contact information for family and friends so everyone can help in the best ways possible.

For my fellow administrators, the book also includes stories... stories of how errors, oversights and mis-communication affected patients and their families.  Is it any wonder that patient experience is included in CMS' Value Based Purchasing program?

The only advice I would add is for patients and their advocates to not be afraid to speak up! First, seek out the manager of the unit or hospital nursing supervisor.  If he or she can't resolve the problem, ask for the Patient Advocate or assigned case manager.  Next in line is the Director of Nursing.  And, if she or he can't help.  Find the administrator's office and request a meeting to discuss your concerns with the quality and safety of the care being provided.  If this doesn't seem to work, just contact me and I'll share a few additional options that you have available.

Also see the Joint Commission's Preventing Errors in Your Care and other resources on their site.

Foursquare in Healthcare

I've been checking in on Foursquare for several months just to experience the technology and think about how it can be applied in healthcare environments.  Healthcare IT News had an article on 5 reasons for medical practices to use FourSquare. 

1. It's easy to use.

2. It's big, and getting bigger.

3. It's a search engine and a way of being found when people are looking for a doctor. 

4. If you don't claim your place, someone else is likely to do it for you.

5. It says your medical practice is social and tech savvy. 

The list is good list, but I'd like to add a few things.

1. Do check to see if your practice is already an identified location on FourSquare and claim your location. Don't let someone else set one up for your practice!
2. Foursquare is another place to find online feedback, so monitor comments for anything that will help you improve your services or that violates protected information or is inappropriate. Remove anything inappropriate.
3. Letting people check-in to your practice on Foursquare gives patients something to do while they are waiting in your office.  Consider adding something a little more engaging, such as health tips or quizzing patients on seasonal health topics.
4. If you aren't sure, try it out for yourself.  Sign up for your own Foursquare account and start checking-in as you go through your day. Maybe you will even earn a few badges like me!

 By the way, I don't share my location with others. It is your decision!

HIE for Consumers

Will from Redwood MedNet sent me a powerful video from Health Information Partnership for Tennessee. The video will help consumers learn and understand more about why health information exchange is important.  In the video, I was pleased to see an old RHIO friend, Dr. Mark Frisse.

There is a surprising twist near the end, so please watch and learn! 

You can also check out their videos for administrators and providers.

HIE Guide for CIOs

CHIME and eHealth Initiative have joined forces to create a Health Information Exchange (HIE) Guide for CIOs. The guide looks to be fairly comprehensive, starting with the background of HIE and continuing to key contract elements with a Health Information Organization (HIO).

I'd also recommend that CIOs explore the toolkits, checklists and other resources being developed by the HIMSS HIE Committee and Workgroup. And this includes the book, Guide to Establishing a RHIO with its review of collaboration and the legal entity and governance models.

If you still have questions after exploring these resources, or need assistance with administrative and governance issues, you can always leave a comment or contact me directly.

Social Media Risks

ECRI has a fairly comprehensive overview and guide on social media that includes some great advice for hospital and other provider human resource managers.  There is also an interesting bit of information related to passwords and data security (see page 15).  My favorites on HR include:

• Be careful with what you find while screening potential employees
• Exercise care before disciplining an employee for what they write on a social media post
• Current employees may one day be former employees so make sure you have educated them on social media and their HIPAA obligations

For those of you who like multimedia, check out the ECRI's video on the guide.

Engaging Staff with Social Media

The Nov/Dec 2011 issue of Healthcare Executive includes an article I wrote for the Satisfying Your Customers column, titled Engaging Staff with Social Media.  In the article I describe how successful leaders will prepare for the shifts occurring in the healthcare workplace; including the push for efficiency and new generations.  I also include a few examples of where social media is contributing to a more effective workplace in hospitals. 

Social media technologies are tools that can help increase customer, physician and employee satisfaction. I hope you will take the time to read the article and share your thoughts.

Another blog post that includes a few great workplace examples is list of 20 hospitals with inspiring social media strategies. 

Is Age Just a Number, or a Challenge to Widespread HIT Adoption?

I was interviewed for a recent article in Becker's Hospital Review that explores the common belief that older adults have more difficulty accepting and using technology.  It includes some great comments about "digital natives" and "digital immigrants" by the other interviewees.   

Speaking for myself, as a late Boomer, I can say that I certainly am a digital immigrant who has embraced technologies as I have found value to my work and life.  And, I believe that this applies to older adults in general.  There are differences in the generations and the oldest may need the most convincing and support, but it isn't that they can't incorporate technology into their daily life.

I remember older adults thinking it was a bit silly for people to carry around a cell phone.  But, once they began to realize value - they feel safer because they can call for help -- then older adults start using the technology just as anyone else.   If I'm correct, I also I believe this is how telephone adoption went.  It took a long time for it to catch on and for people to find value in the technology.  

Health IT is just one more advancement that needs to progress through the adoption cycle.

 

Candy Stripers and Junior Volunteers

I've posted on the subject of volunteers, young people working in hospitals and those considering a career in healthcare administration, previously.  However, this last week, I've been specifically researching Candy Stripers, who are sometimes referred to as Junior Volunteers.

Candy Stripers at Doctors Memorial Hospital, FL

I'd love to here your thoughts or stories about the youngest of our hospital workforce!  If you prefer something more personal, send me an email: Christina {at} cthielst {dot} com

I'm thinking I should also start researching the Pink Ladies, too!

ACP Ethics Manual on Social Media, Catastrophes, and More

The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism.  I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.

• Communication through email or other electronic means can supplement face-to-face encounters; however, it must be done under appropriate guidelines. Issuance of a prescription or other forms of treatment, based only on an online questionnaire or phone-based consultation, does not constitute an acceptable standard of care. (Exception: on-call situations) (pg 75)

• Shifting principles guide the patient-physician relationship during catastrophes and physicians need to be prepared for decision making and the just delivery of healthcare. (pg 80)

• Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries.  They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the the clinic to the online setting.  Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient-physician interactions, as well as, online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public. (pg 81)

 

 All Changes to the Manual since the 2005 (fifth) edition

Report on Hospital Acquired Infection in CA Released

Healthcare-associated infection data on all hospitals in Califorinia has been released by the California Department of Public Health (CDPH).  This means anyone can see the nosocomial infection rates of their local hospital by unit.  But, I urge some caution among consumers with comparing rates of different hospitals and units. Instead, this data should be used to prepare questions and for a discussion with your physician or the hospital.  Hospitals may be interested in using this data to benchmark themselves against other hospitals.

Healthcare-associated infections (HAIs) are infections that patients develop during the course of receiving healthcare treatment for other conditions. They can happen following treatment in healthcare facilities including hospitals as well as outpatient surgery centers, dialysis centers, long-term care facilities such as nursing homes, rehabilitation centers, and community clinics. They can also occur during the course of treatment at home. They can be caused by a wide variety of common and unusual bacteria, fungi, and viruses.

HAIs are the most common complication of hospital care, occurring in approximately one in every 20 patients. The following HAIs occurring in hospitalized patients are required to be reported to the CDPH by all California general acute care hospitals:

• Central-line associated bloodstream infections;
• Clostridium difficile infections;
• Methicillin-resistant Staphylococcus aureus (bloodstream)
• vancomycin-resistant Enterococcus (bloodstream)
• Surgical site infections

Data is also available on a couple of hospital practices that that contribute to a reduction in HAI rates and length-of-stay.

• Central-line insertion practices 
• Staff influenza vaccination rate 

 

 

Gartner Worldwide IT Spending Forecast

I participated in this morning's Gartner Worldwide IT Spending Forecast.  Gartner, the technology research giant, brought together some wonderful speakers who shared information that I feel is important to healthcare -- especially at this moment in time.  The issues will have major revenue implications for vendors (perhaps leading to service changes) and could delay current and planned IT initiatives (EHR adoption, HIE, etc) of healthcare organizations.

The floods in Thailand in October of 2011 severely impacted fabrication facilities and this has lead to a shortage of hard drives. It is predicted that it will take at least until the 3rd or 4th quarter of 2012 for the industry to get back to meeting demand.  There is some uncertainty about this timeline.

This means:

• There will be storage and server component shortages.  Storage will not be cheap and providers will need to be efficient.
• Virtualization (the cloud) may be a more affordable option.
• We can expect longer lead times for delivery, backlogs and double ordering of products.
• We can expect an increase in costs over the short term (re-assess those budget projections you made last year)

One lesson that comes from this situation is to have multiple geographic locations for the manufacturing of components to help prevent business disasters like this one.  In this case all of our (the world's) eggs (hard drives) are manufactured in one basket (Thailand).

PC and software spending is down due to the downturn in the economy.  But, there was one bit of good news that I pulled from the discussion on software.  Spending on software (tools) for collaboration is increasing.  Companies are investing in technologies that will help them stay competitive and this means tools that will help their employees collaborate will reduce the need to bring on additional people. 

Now, I've been seeing this in other industries and have started to see it trickle into healthcare.  With health reform upon us, I hope my friends in the hospital start thinking a little more out of the box and how they too can leverage collaborative tools (aka social media) to improve efficiency and effectiveness in the workplace.

Low Health Literacy: Impact on Costs

The American College of Physicians has a YouTube video that demonstrates the impact of low health literacy on the healthcare delivery system and costs.  Healthcare administrators and clinicians should view this video to see the challenges for themselves.  Notice the potential for medication errors alone! 

It reminds me of Louise, the discharge advocate!

 

This video hits a little close to home since LSU Shreveport seems to have been involved and a few of the accents were familiar.  However, this is an issue across the US.

Top 11 Trends for 2012 in Healthcare Data

A look ahead at healthcare data points to increased risks, regulatory expectations and reputational fallout.  So it was a pleasure that I could contribute to a list of the top 10 trends for 2012 in healthcare data.  And, I really do appreciate so may news organizations carrying the story.  

My hope is that by increasing awareness of the risk among both healthcare providers and consumers, the necessary safeguards will get implemented.  The top 2012 predictions in healthcare data are:

1. Healthcare organizations will not be immune to data breach risks caused by the spread of mobile devices in the workforce
2. Class-action litigation firestorms are imminent
3. Social media risks in healthcare will grow
4. Cloud computing is not a panacea; technology is outpacing security and creating unprecedented liability risks
5. Growing reliance on business associates will create new risks
6. Organizations risk reputation fallout
7. Mobile will explode in healthcare 
8. Increased emphasis on willful neglect leads to increased enforcement of HIPAA
9. Privacy and security training will be an annual requirement
10. Rise in  fraudsters will increase fraud risk education
11. Healthcare organizations will turn to cyber liability insurance

See PR Newswire for the complete release.

NIMS: Guidance for HPP 2012

The NIMS objectives for hospitals have been reduced from 14 to 11 and there is some new clarification and guidance.  The changes, effective July 1, 2012, include:

Combining Object s 8 & 10:  Promote and ensure that hospital processes, equipment, communication and data interoperability facilitate the collection and distribution of consistent and accurate information with local and state partners during an incident or event

Combining Objectives 11 & 12:  Manage all emergency incidents, exercises, and preplanned (recurring/special) events with consistent application of ICS organizational strucutres, doctrine, processes and procedures.

Combining Objectives 13 & 14:  Adopt the principle of Public Information, facilitated by the use of the Joint Information System (JIS) and Joint Information Center (JIC) ensuring that Public Information procedures and processes gather, verify, coordinate and disseminate information during an incident or event.

Revised guidance for personnel requiring NIMS related training (reduced emphasis on IS 800 for hosptial staff and clarification of staff needing IS 100, 200 and 700) Note:  From reading the Implemention Guidance I'm not reallying seeing a reduced emphasis on IS800.  I'll follow-up on this one and report back.

Each of the 11 objectives are important, because compliance is a condition to receive Federal Preparedness Assistance, such as receipt of funds from the Hospital Preparedness Program.  These funds are to be used to maintain, refine and enhance healthcare organization capabilities, as well as, exercising and improving preparedness plans for all hazards.

In addition, compliance with NIMS is also required for receipt of some FEMA funds after a declared disaster has impacted a healthcare organization.

I'm preparing to audit several hospitals in 2012 for compliance with the NIMS Objectives and welcome you to contact me if I can do the same for you.  Write to Christina {at} cthielst {dot} com.

 

 

Employee Makes Fun of Patient on Facebook

When will our employees learn not to identify patients on Facebook or any other social media site.  This recent example goes beyond a simple error in judgment to a complete disregard for patient privacy and respect by the employee of a staffing agency working at a hospital in Southern California.

The patient involved sought treatment for an STD and the employee took a picture of her medical record and posted it on his Facebook page with the comment:  "Funny, but this patient came in to cure her VD and get birth control."

I've read the article a couple of times and discussed it with other healthcare leaders.  The following come to mind:

1.  First, there is the policy and staff training/education that must occur by all providers on social media in the healthcare setting.

2.  Beyond the policy and training, we need to consider the character of the person we are hiring or bringing into our environment of care.  They may be the best ER nurse in the world, but if they have a complete disregard for patient privacy and respect, you may not want them working with your patients.

3.  Clues may come from looking at what it is like to work with someone.  This agency employee's response to the post is that he would leave the post up and he writes:

"People, it's just Facebook... Not reality.  Hello?  Again...It's just a name out of millions and millions of names.  If some people can't appreciate my humor than tough.  And if you don't like it too bad because it's my wall and I'll post what I want to. Cheers!"

Is this his attitude with co-workers about other disagreements?  Is this really someone we want working in healthcare or any other caring profession?

4. Contracts with vendors, including staffing agencies, should already address their employee use of social media ... in line with your organization's policy.  And, their staff should be trained before they are allowed to begin working with your patients and in your healthcare environment.

5. The younger generations of healthcare workers are using social media, especially on mobile devices, on a daily and hourly basis.  As healthcare leaders, we need to educate and guide them in understanding the boundaries between their personal and professional lives. 

6.  As Thomas Friedman states in his book, The World is Flat, "we {as healthcare leaders} really do have to find ways to affect the imagination of those who would use the tools of collaboration to destroy the world that has invented those tools."

7.  Disbarment:  The Feds have a list of disbarred individuals who have inappropriately used federal funds.  I think it is time that they create a new list of individuals who are disbared from ever caring, treating or working around Federal beneficiaries.  This guy should be first on the list!

Cool Map of Hospital Social Media Use

Ed Bennet has a really cool map displaying social media use by hospitals.  If you haven't already, you should visit his blog Found in Cache, which includes some great hospital social media resources.

Thanks for sharing your list and the map, Ed!

Company Sues Former Employee Over Twitter Account

Here is a new example of where having a comprehensive social media policy will come in handy for minimizing risks and associated legal costs.  It involves an employee who left an Internet company and took a Twitter account being used for business purposes.  This includes all of the followers that had been built-up over his tenure -- who are now receiving tweets from a competitor business.  So now, there is a lawsuit over ownership and value of the followers.

Having a policy that clearly stated that the account was the property of the business and implementing appropriate steps to secure the account at the time of the employee's departure would have saved much grief for both parties.  For those who have authority to engage on the healthcare organization's social media channels, changing passwords to secure the account should occur at the same time you are collecting ID badges, keys and other property.

I've been hearing a push for have simple one page social media policies and I agree that a concise policy is best.  However, I fear some healthcare organizations will eliminate important details in an effort to keep the policy short.   It all comes down to negotiating the language with risk management and legal advisers.