Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.
First we have:
After the needless death of his father, the author, a business executive, began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. Here’s a radical solution to an agonizing problem.
by David Goldhill
How American Health Care Killed My Father
Almost two years ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.
About a week after my father’s death, The New Yorker ran an article by Atul Gawande profiling the efforts of Dr. Peter Pronovost to reduce the incidence of fatal hospital-borne infections. Pronovost’s solution? A simple checklist of ICU protocols governing physician hand-washing and other basic sterilization procedures. Hospitals implementing Pronovost’s checklist had enjoyed almost instantaneous success, reducing hospital-infection rates by two-thirds within the first three months of its adoption. But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them. The story chronicled Pronovost’s travels around the country as he struggled to persuade hospitals to embrace his reform.
It was a heroic story, but to me, it was also deeply unsettling. How was it possible that Pronovost needed to beg hospitals to adopt an essentially cost-free idea that saved so many lives? Here’s an industry that loudly protests the high cost of liability insurance and the injustice of our tort system and yet needs extensive lobbying to embrace a simple technique to save up to 100,000 people.
And what about us—the patients? How does a nation that might close down a business for a single illness from a suspicious hamburger tolerate the carnage inflicted by our hospitals? And not just those 100,000 deaths. In April, a Wall Street Journal story suggested that blood clots following surgery or illness, the leading cause of preventable hospital deaths in the U.S., may kill nearly 200,000 patients per year. How did Americans learn to accept hundreds of thousands of deaths from minor medical mistakes as an inevitability?
My survivor’s grief has taken the form of an obsession with our health-care system. For more than a year, I’ve been reading as much as I can get my hands on, talking to doctors and patients, and asking a lot of questions.
Keeping Dad company in the hospital for five weeks had left me befuddled. How can a facility featuring state-of-the-art diagnostic equipment use less-sophisticated information technology than my local sushi bar? How can the ICU stress the importance of sterility when its trash is picked up once daily, and only after flowing onto the floor of a patient’s room? Considering the importance of a patient’s frame of mind to recovery, why are the rooms so cheerless and uncomfortable? In whose interest is the bizarre scheduling of hospital shifts, so that a five-week stay brings an endless string of new personnel assigned to a patient’s care? Why, in other words, has this technologically advanced hospital missed out on the revolution in quality control and customer service that has swept all other consumer-facing industries in the past two generations?
I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.
Like every grieving family member, I looked for someone to blame for my father’s death. But my dad’s doctors weren’t incompetent—on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate. Nor from financial limitations—he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.
Indeed, I suspect that our collective search for villains—for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that—most important—remove consumers from our irreplaceable role as the ultimate ensurer of value.
These are the impersonal forces, I’ve come to believe, that explain why things have gone so badly wrong in health care, producing the national dilemma of runaway costs and poorly covered millions. The problems I’ve explored in the past year hardly count as breakthrough discoveries—health-care experts undoubtedly view all of them as old news. But some experts, it seems, have come to see many of these problems as inevitable in any health-care system—as conditions to be patched up, papered over, or worked around, but not problems to be solved.
Much, much more here:
http://www.theatlantic.com/doc/200909/health-care
Mandatory reading for those who want to understand the US health system and the amazing perverse incentives that are going to bankrupt the US unless fixed. (runs to over 20 pages but really worth the read!)
Second we have:
More than 50% of state CIOs working on HIT: report
By Joseph Conn / HITS staff writer
Posted: August 24, 2009 - 11:00 am EDT
Another indication that states—and not regions—may be the cornerstones of health information exchange is that so many state information technology officers are already involved in building exchanges within their jurisdictions, according to a professional association of state government IT officials.
The National Association of State Chief Information Officers, or NASCIO, in a recent report, “Profiles of Progress III: State Health IT Initiatives,” concluded that more than half of state CIOs “were involved at some level with state-driven health IT initiatives … even though financial resources were often uncertain at best.”
The game has changed since the American Recovery and Reinvestment Act of 2009 was passed in February, according to the Lexington, Ky.-based association. The stimulus law provides an estimated $34 billion through Medicare and Medicaid for electronic health-record subsidies for office-based physicians and hospitals. It also appropriated $2 billion for use by HHS' Office of the National Coordinator for Health Information Technology to fund grants to promote IT adoption and information exchange.
More here:
http://www.modernhealthcare.com/article/20090824/REG/308249941
It is wonderful to see how billions motivate. Link to the report is in the text.
Third we have:
Twitter And Health Care -- Can A Tweet A Day Keep The Doctor Away?
ScienceDaily (Aug. 24, 2009) — Twitter, the increasingly popular social networking tool that was at first merely a convenient way to stay in touch with friends and family, is emerging as a potentially valuable means of real-time, on-the-go communication of healthcare information and medical alerts, as described in a feature article in the Medical Connectivity section of the latest issue of Telemedicine and e-Health.
Physician groups, hospitals, and healthcare organizations are discovering a range of beneficial applications for using Twitter to communicate timely information both within the medical community and to patients and the public. Short messages, or "tweets," delivered through Twitter go out from a sender to a group of recipients simultaneously, providing a fast and easy way to reach a lot of people in a short time. This has obvious advantages for sharing time-critical information such as disaster alerts and drug safety warnings, tracking disease outbreaks, or disseminating healthcare information. Twitter applications are available to help patients find out about clinical trials, for example, or to link brief news alerts from the Centers for Disease Control and Prevention (CDC) to reliable websites that provide more detailed information.
Much more here:
http://www.sciencedaily.com/releases/2009/08/090824141043.htm
Interesting article on where Twitter might fit..
The full article and a policy article on Telemedicine and US Health Reform are free on line here.
http://www.liebertonline.com/toc/tmj/15/6
Fourth we have:
Federal funding key to HIT acceleration: report
By Joseph Conn / HITS staff writer
Posted: August 25, 2009 - 11:00 am EDT
One of the key goals of the health information technology financial subsidy provisions of the American Recovery and Reinvestment Act of 2009 is to boost the adoption of electronic health-record systems, particularly at smaller hospitals where studies have shown adoption rates are lower than at larger hospitals.
Just as Congress calculated in larding the recovery legislation with financial incentives, it would appear that money talks.
The prospect of a massive infusion of federal dollars to subsidize EHR purchases—estimated at $34 billion through the Medicare and Medicaid programs alone—was cited as a key reason for an accelerated schedule of IT purchases planned by community hospitals, according to a survey of IT leaders and other community hospital officials conducted by Orem, Utah-based KLAS Enterprises, a market research firm.
And among IT system vendors, according to KLAS, those with a reputation for physician-friendliness are doing well in terms of “mind share” of prospective purchasers. That's because current recommendations for the “meaningful use” criteria that providers must meet to qualify for federal subsidies call for early implementation and some level of use of computerized physician order-entry systems, according to the firm. As a result, some vendors whose products are not typically associated with the small hospital market are at least being considered by community hospital buyers, the KLAS researchers said.
This 104-page report, Disruption in Community HIS Purchases: It's All About Physician Adoption, said it is “a compilation of data gathered from Web sites, healthcare industry reports, interviews with healthcare provider executives and managers, and interviews with vendor and consultant organizations.” (“HIS” is an acronym for hospital information systems.)
KLAS said the report is based on interviews with officials from 64 organizations with hospitals of fewer than 200 beds. About 70% of interviewees were chief information officers, 13% were IT directors, 8% were CEOs or chief financial officers and the remainder were healthcare officials who were “planning to evaluate and purchase” a health information system “within the next few years,” KLAS said. Nearly half plan to make a purchase decision in the next 12 months, the report said.
Much more here:
http://www.modernhealthcare.com/article/20090825/REG/308259981
The report can be purchased here:
http://www.klasresearch.com/Klas/site/Store/ReportDetail.aspx?ProductID=514
Fourth we have:
Personal view: Tim Benson
26 Aug 2009
Standards guru Tim Benson argues that understanding health interoperability, HL7 and SNOMED CT will become increasingly important in this taster of his new book.
When we look back over seven years of the National Programme for IT in the NHS, one of the greatest disappointments has been the failure of NHS Connecting for Health to deliver, implement and deploy the full suite of interoperability standards needed to deliver the right information at the right time and the right place, right across the health service.
Only a small subset of the stringent standards for interoperability called for by Derek Wanless in his report for the Treasury on the future funding needs of the NHS have been delivered; and these mainly consist of links to and from the central Spine. Where are the rest?
Look across the pond
Each of the ‘Clinical 5’ set out by the NHS Informatics Review in 2008 depends on standards to exchange information within and between provider organisations. The standards that are needed have not been agreed nationally, let alone implemented or deployed.
One of the priorities for our national health informatics strategy should be to mandate that all suppliers support nationally agreed interoperability standards for these and other use cases.
We should take note of what is happening in the USA. One of the first very first acts of the Obama administration was to establish by law a federal advisory committee to recommend standards to be used for electronic exchange and use of health information (see http//:healthit.hss.gov).
Understanding interoperability
The base standards of healthcare interoperability are HL7 and SNOMED CT, but these are base standards, not plug and play solutions out of the box. For each and every task, we have to set out and agree stringent specifications or “profiles”, based on the base standards. Each profile must be implemented and deployed in systems at both ends before any information can flow.
Confusingly, the term interoperability applies to three different skill sets; technical interoperability, computable semantic interoperability and process interoperability. Technical interoperability just gets data from A to B, reliably. This is now a commodity, as demonstrated by the Internet and the New NHS Network (N3).
Our immediate focus is computable semantic interoperability, which is to transfer data from system A to system B in a form that system B can process and use – not just display. Electronic data interchange (EDI) of this type typically involves a two-stage translation process.
The first translation is from system A’s local data structure and codes into an appropriate message standard typically using HL7 with SNOMED CT codes. The second translation is from the common standard into the codes and data structures used by system B.
Each message has to be translated twice, by a different set of computer programmers at each end. The avoidance of all error or misunderstanding at this stage is one of the greatest challenges. It is the main reason why interoperability is hard.
Process interoperability occurs when we re-engineer the business processes at each end to provide a much better service. This can only be done once the links are working, but it is the only way to realise the potential benefits of interoperability.
Lots more vital reading here:
http://www.e-health-insider.com/comment_and_analysis/501/personal_view:_tim_benson
This man is one of the global experts (a genuine guru) in the area:
Access his book while you still can.
The full text of Tim Benson’s new book on HL7 and SNOMED is available for download from his web-site - www.abies.co.uk – and will remain so until the book itself is published in November. Benson also runs courses on standards.
Fifth we have:
Pediatrics has unique EMR and HIT needs
August 27, 2009 — 1:15pm ET | By Neil Versel
What works for adults may not be so suitable for children. That's the lesson of a new report on health IT for pediatric care from two California research organizations.
"Children have different health needs, are often served by different caregivers and in different care settings, and in some cases require HIT with different functionality than adults," says the report, a joint effort of the Health Technology Center and The Children's Partnership.
.....
More here:
http://www.fierceemr.com/story/pediatrics-has-unique-emr-and-hit-needs/2009-08-27
For more:
- check out this Healthcare IT News story
- download the report
An obvious truth – but worth raising sooner rather than later.
Sixth we have:
An Effective, If Odd, E-Health Tool
Posted by Mitch Wagner on August 25, 2009 10:46 AM
I admit to having a twisted sense of humor, so I got a lot of laughs out of the CDC's page of e-cards for all occasions--so long as the occasions are celebrated by hypochondriacs.
I especially enjoyed this card to remind people to get prostate cancer exams. And when I say "enjoyed," I mean, of course, "laughed like an 11-year-old at a Three Stooges festival." I mean, for what occasion do you send a prostate exam e-card? Do I even want to know?
More here:
Other cards you can send include:
I suppose this is a good idea?
Lastly we have:
Tuesday, August 25, 2009
Work Groups Favor Phasing in Health IT Standards
Once the U.S. health care system completes the transition to digital record keeping, privacy advocates say patients should control where their medical information goes.
That, ultimately, may become standard procedure, but the country's not ready to go there yet, according to the privacy and security work group of the federal Health IT Standards Committee.
"The consent management portion of this is really the nub of the issue," said Steve Findlay, co-chair of the nine-member work group. "We discussed this quite a bit, and we came to the conclusion that measures of consent management are just not ready for prime time. We have to kick that can down the road for a time," Findlay said last week as part of his work group's report to the full Health IT Standards Committee. Findlay represents Consumers Union on the panel.
Like many of the recommendations by other Standards Committee work groups, the privacy and security work group said movement toward ultimate goals would have to be incremental.
"This is a journey with short-term and long-term goals," John Halamka, vice chair of the Standards Committee, said, adding, "Security and privacy are foundational to everything we do, but like other groups, there will be changing goals as our capabilities change."
In updating earlier recommendations on how electronic health records could comply with HIPAA privacy and security rules, the privacy and security work group spelled out some details, but also at times used broad terms to allow for many possibilities.
For instance, some of the work group's recommendations dealing with encryption intentionally avoided offering specific possibilities such as flash drives or other devices.
"Integrity of data is absolutely essential," said Dixie Baker, co-chair of the privacy and security work group. "Some of our most detailed discussion was in the area of encryption. What we finally agreed upon was to phrase it in such a way to force (EHR users) to think through what was possible," Baker said. Baker represents Science Applications International Corporation on the Standards Committee.
Quality, Data Standards To Be Phased In
Two other work groups -- clinical quality and clinical operations -- also recommended phasing in standards for EHRs as called for in the American Recovery and Reinvestment Act. The records would start simply, using a variety of coding techniques and eventually grow more detailed using one set of codes only.
Much more here:
http://www.ihealthbeat.org/Features/2009/Work-Groups-Favor-Phasing-in-Health-IT-Standards.aspx
MORE ON THE WEB
- Clinical operations work group recommendations
- Clinical quality work group recommendations
- Privacy and security work group recommendations
These 3 PowerPoint presentations reflect US progress with very important stuff we should be watching closely here in Australia. None of these issues is unique to the US at all. The concept of ‘meaningful use’ linked to funding seems to be mobilising all sorts of good things so far.
Well worth the downloads.
Enough goodies for one week!
Enjoy!
David.
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