| Health Language, Inc. (HLI), the global leader in medical terminology management, announced the addition of a procedure category to its provider friendly terminology (PFT) code set that includes 40,000 synonyms, abbreviations and colloquial expressions that are commonly used by healthcare professionals when documenting or searching for patient data. Combining the new procedure category with HLI's robust diagnosis content and enabling tools creates the industry's most comprehensive and functional PFT code set. Clinicians, hospitals and independent delivery networks benefit from the resulting interoperability that facilitates health information exchange and complying with meaningful use requirements such as the creation of problem lists, as well as seamless billing and other administrative functions. Based on the ICD-9 procedure standard, the expanded PFT enables intuitive searching of procedures such as surgeries and includes maps to other widely used terminologies such as SNOMED CT and ICD-10-PCS. The unmatched versatility of the PFT, which is available as a flat file and through HLI's Language Engine and its cloud-based, scalable Language Engine Access Portal (LEAP), enables providers of all sizes and levels of HIT adoption to easily utilize the data. They gain access to all major code sets and can use their existing tools in conjunction with the flat file or access HLI's arsenal of tools that have been adopted worldwide to ease data collection, organization and reporting for a electronic health record (EHR) and other health information technology (HIT) applications. According to HLI's Chief Medical Officer Brian Levy, M.D., "The ability for physicians, nurses and other clinicians to continue using their preferred clinical terms and descriptions will help encourage broader EHR adoption. Additionally, many EHRs and other clinical and administrative applications are dependent on standardized medical terminologies and billing classifications unfamiliar to clinicians. For example, HLI has created five synonyms for an open biopsy of lung based on physician usage patterns: open bx of lung, open pulmonary biopsy, open lung biopsy, open lung bx, and open pulmonary bx." Dr. Levy added, "Utilizing HLI's provider friendly terminology simplifies the transition to an EHR and helps physicians maintain their productivity by accommodating their existing workflow and preferences rather than forcing them to adjust to constantly evolving codes, standards and reporting mandates." About Health Language Denver-based Health Language, Inc. (HLI) develops and delivers state-of-the-art software solutions that automatically incorporate medical vocabulary and coding standards into healthcare information technology (HCIT) applications. HLI's Language Engine (LE) allows centralized access to medical terminology standards and generates mappings to create a common pool of standardized codes and concepts that enhance patient safety, facilitate clinical outcomes analysis and accelerate reimbursement. It also provides standards for modeling, storing, updating and distributing information consistently for interoperability between hospitals, regions and countries. For more information, visit www.healthlanguage.com or call 720-940-2900. |
Tuesday, November 30, 2010
Health Language Adds New Procedure Category to PFT
Monitoring Radiation Doses to Improve Patient Safety
Keeping radiation dose in check is a top patient safety concern for today’s hospitals, particularly in computed tomography (CT), which has undergone some significant technological advances in the last ten years. The down side is that CT delivers some of the highest radiation doses in diagnostic radiology. Failing to implement measures for delivering the appropriate radiation dose can result in unnecessarily high exposures, placing patients at increased risk of cancer and other injuries. A recent New York Times article addresses some of these rare but serious incidents.
So, how can hospitals take action now to ensure they are not exposing patients to dangerous levels of radiation?
Answering this question is complicated, and can even be counterintuitive, according to ECRI Institute (www.ecri.org), an independent, nonprofit organization that researches the best approaches to patient care. While a high level of radiation puts patients at risk, too little could affect image quality—possibly resulting in misdiagnosis or the need for patients to be rescanned and exposed to even more radiation.
To help healthcare facilities ensure their CT radiation dosages are at a safe level, ECRI Institute has introduced a CT Radiation Dose Safety Review service. ECRI Institute’s multidisciplinary experts, including medical physicists who specialize in diagnostic imaging, conduct a thorough assessment of a hospital’s CT service, including current policy and procedures, staff, and technologies. Then, they identify vulnerabilities in safety and quality, and help implement changes to minimize the likelihood of patient harm from excessive radiation dosage.
“We’re identifying patient safety concerns with a hospital’s current CT service, then working with its staff to establish a practical solution based on that specific facility’s operations,” says Rohit Inamdar, Senior Associate and Medical Physicist, ECRI Institute. “We want hospitals and the physicians who conduct CT procedures to be confident that they are protecting patients from excessive radiation while still providing quality images.”
CT scans offer exquisite images of human anatomy, including the beating heart. These images help physicians diagnose and guide treatment for stroke, cancers and more. And, new applications of CT scans, including virtual colonoscopy, brain perfusion and lung screening, continue to develop.This is why hospitals should take action now, says Jason Launders, MSc., Senior Project Officer and Medical Physicist, ECRI Institute. “CT provides precise images and tremendous benefits to patients. But, neglecting the radiation dose will, without a doubt, lead to unnecessary and unwanted consequences.”
Development of the CT Radiation Dose Safety Review service is the latest in ECRI Institute’s initiatives to keep CT radiation dosage at safe levels. In April, the organization released a Health Devices guidance article, “CT Radiation Dose: Understanding and Controlling the Risks,” aimed at helping users strike the delicate balance between too much and not enough radiation.
For more information about ECRI Institute’s CT Radiation Dose Safety Reviews, call (610) 825-6000, ext. 5277, or email consultants@ecri.org.
About ECRI Institute
ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. Strict conflict-of-interest guidelines ensure objectivity. ECRI Institute is designated a Collaborating Center of the World Health Organization and an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality. ECRI Institute PSO, listed as a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services, strives to achieve the highest levels of safety and quality in healthcare by collecting and analyzing patient safety information and sharing lessons learned and best practices.
So, how can hospitals take action now to ensure they are not exposing patients to dangerous levels of radiation?
Answering this question is complicated, and can even be counterintuitive, according to ECRI Institute (www.ecri.org), an independent, nonprofit organization that researches the best approaches to patient care. While a high level of radiation puts patients at risk, too little could affect image quality—possibly resulting in misdiagnosis or the need for patients to be rescanned and exposed to even more radiation.
To help healthcare facilities ensure their CT radiation dosages are at a safe level, ECRI Institute has introduced a CT Radiation Dose Safety Review service. ECRI Institute’s multidisciplinary experts, including medical physicists who specialize in diagnostic imaging, conduct a thorough assessment of a hospital’s CT service, including current policy and procedures, staff, and technologies. Then, they identify vulnerabilities in safety and quality, and help implement changes to minimize the likelihood of patient harm from excessive radiation dosage.
“We’re identifying patient safety concerns with a hospital’s current CT service, then working with its staff to establish a practical solution based on that specific facility’s operations,” says Rohit Inamdar, Senior Associate and Medical Physicist, ECRI Institute. “We want hospitals and the physicians who conduct CT procedures to be confident that they are protecting patients from excessive radiation while still providing quality images.”
CT scans offer exquisite images of human anatomy, including the beating heart. These images help physicians diagnose and guide treatment for stroke, cancers and more. And, new applications of CT scans, including virtual colonoscopy, brain perfusion and lung screening, continue to develop.This is why hospitals should take action now, says Jason Launders, MSc., Senior Project Officer and Medical Physicist, ECRI Institute. “CT provides precise images and tremendous benefits to patients. But, neglecting the radiation dose will, without a doubt, lead to unnecessary and unwanted consequences.”
Development of the CT Radiation Dose Safety Review service is the latest in ECRI Institute’s initiatives to keep CT radiation dosage at safe levels. In April, the organization released a Health Devices guidance article, “CT Radiation Dose: Understanding and Controlling the Risks,” aimed at helping users strike the delicate balance between too much and not enough radiation.
For more information about ECRI Institute’s CT Radiation Dose Safety Reviews, call (610) 825-6000, ext. 5277, or email consultants@ecri.org.
About ECRI Institute
ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care. As pioneers in this science for more than 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. Strict conflict-of-interest guidelines ensure objectivity. ECRI Institute is designated a Collaborating Center of the World Health Organization and an Evidence-based Practice Center by the U.S. Agency for Healthcare Research and Quality. ECRI Institute PSO, listed as a federally certified Patient Safety Organization by the U.S. Department of Health and Human Services, strives to achieve the highest levels of safety and quality in healthcare by collecting and analyzing patient safety information and sharing lessons learned and best practices.
Saturday, November 27, 2010
CareFusion Selects Palomar Pomerado Health for Development Partner
San Diego, October 26, 2010—Palomar Pomerado Health (PPH), a Magnet® designated health system located in North County, San Diego, has been selected by San Diego-based CareFusion, a global medical technology company, as a development partner for the latest Pyxis technologies that focus on improving patient safety and cost of health care.
As a partner in innovation with CareFusion, PPH physicians, nurses, pharmacists, respiratory therapists and information technology leadership will provide feedback on new and current medication and supply management technologies in the patient care environment around functionality, workflow, efficiency and more. This also means that patients will have access to these marketing-leading technologies that have been proven to help reduce medication errors, decrease the turn-around time for patients to receive critical medications and increase hospital workflow efficiencies so nurses and doctors can spend more time on direct patient care.
"Part of our customer-centric development process is to gather clinician feedback and test our products in a best-in-class, acute care environment, like Palomar Pomerado Health hospitals," said Tom Leonard, president of Dispensing Technologies at CareFusion. "We are excited to be working with a local health system to innovate new, global technologies that improve patient safety, while lowering the overall costs of health care."
"This new development partnership with Care Fusion will enable PPH to lead the industry in terms of the adoption of innovative solutions in the medical dispensing arena," said Orlando Portale, Chief Innovation Officer, Palomar Pomerado Health. "Working closely with the CareFusion research and development team, we will translate new conceptual models into next generation capabilities that will streamline key care-delivery and management processes."
About Palomar Pomerado Health
Palomar Pomerado Health (PPH), California's largest public health system is North County's most comprehensive health-care delivery system, and is the only Magnet(R) Recognized public health system in the state. It is nationally recognized for clinical excellence in cardiac care, women's services, cancer, orthopedics, trauma, rehabilitation and behavioral health services. As the largest employer in Inland North County, with more than 3,600 employees and 700 physicians, PPH was named by Modern Healthcare as one of the Top 100 places to work in the United States. Facilities include Palomar Medical Center, Pomerado Hospital, Villa Pomerado, Palomar Continuing Care Center, the Jean McLaughlin Women's Center, Escondido Surgery Center, PPH expresscare health centers, and soon, Palomar Medical Center West - Hospital of the Future, which will open in 2012. Visit www.pph.org for more information on our comprehensive services and facilities.
About CareFusion Palomar Pomerado Health (PPH), California's largest public health system is North County's most comprehensive health-care delivery system, and is the only Magnet(R) Recognized public health system in the state. It is nationally recognized for clinical excellence in cardiac care, women's services, cancer, orthopedics, trauma, rehabilitation and behavioral health services. As the largest employer in Inland North County, with more than 3,600 employees and 700 physicians, PPH was named by Modern Healthcare as one of the Top 100 places to work in the United States. Facilities include Palomar Medical Center, Pomerado Hospital, Villa Pomerado, Palomar Continuing Care Center, the Jean McLaughlin Women's Center, Escondido Surgery Center, PPH expresscare health centers, and soon, Palomar Medical Center West - Hospital of the Future, which will open in 2012. Visit www.pph.org for more information on our comprehensive services and facilities.
CareFusion is a global corporation serving the health care industry with products and services that help hospitals measurably improve patient care. The company develops market-leading technologies including Alaris(R) IV pumps, Pyxis(R) automated dispensing and patient identification systems, AirLife(TM), AVEA(R) and LTV(R) series of ventilators and respiratory products, ChloraPrep(R) skin prep products, MedMined(TM) services for infection surveillance, V. Mueller(R) and Snowden-Pencer(R) surgical instruments and NeuroCare diagnostic products. CareFusion employs more than 15,000 people across its global operations. More information may be found at www.carefusion.com.
The Leapfrog CPOE Evaluation Tool: One Academic Medical Center's Experience
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| Nov Dec Patient Safety & Quality Healthcare |
A large proportion of medication errors occur at the prescribing phase. Computerized provider order entry (CPOE) offers a possible means by which to avoid these potentially harmful mistakes through implementation of electronic ordering and clinical decision support software (Kuperman, et al., 2007). Prior studies have demonstrated that CPOE and decision support reduce medication errors (Kadmon, et al., 2009; Kaushal, et al., 2003; Kuperman, et al., 2003), with less evidence directly linking this technology to a reduction of adverse drug events (Peterson, et al., 2005; Wolfstadt, et al., 2008). Despite these advantages, only 17% of healthcare institutions have fully implemented CPOE, and even fewer are using CPOE with decision support (Jha, et al., 2009; Pedersen, et al., 2008). The software is not only expensive but also requires resources to integrate it into the current information technology (IT) infrastructure, train staff, and support ongoing maintenance. Some institutions favor less expensive alternatives—such as barcode medication administration—as a patient safety investment (Scanlon, et al., 2008).
Formed following publication of the highly publicized Institute of Medicine report, To Err Is Human, in 2000, the Leapfrog Group is a coalition of healthcare purchasers with a mission to help make great "leaps forward" in the patient safety and quality of healthcare (Kilbridge, et al., 2006). The group's strategy centers on a set of purchasing principles voluntarily agreed to by member purchasers that target consumer awareness and provide incentives to patients and providers based on the comparative value of healthcare delivery. Ideally, these principles would create a business case for providers and hospitals to drive advancements in safety and quality (Milstein, et al., 2000). Recognizing the need to promote CPOE adoption, the group selected CPOE as one of its four safety standards. The CPOE standard targets medication prescribing error reduction, one of several capabilities of these order entry systems. To this end, the Leapfrog CPOE evaluation tool was designed to assess the error trapping performance of implemented CPOE systems. Metzger and colleagues recently reported on the wide variability in performance of CPOE decision support across 62 U.S. hospitals using the Leapfrog tool (Metzger, et al., 2010). In this article, we describe our institution's experience with the adult and pediatric versions of the CPOE evaluation tool for inpatients.
To read the full article please visit Patient Safety & Quality Healthcare
Patient Safety and Savings in Las Vegas
As one of the country's fastest-growing cities in the early 21st century, Las Vegas, Nevada, has had to shoulder all the demographic challenges that distinction entails. Through it all, University Medical Center (UMC) has steadfastly maintained its role as the safety net for the sickest and neediest patients in this metro area of nearly two million people. UMC, a 565-bed facility affiliated with the University of Nevada School of Medicine, combines the role of county hospital with that of Nevada's only Level 1 Trauma Center, only burn-care unit, and a world-class children's hospital.
Founded in 1931 to serve workers building nearby Hoover Dam and operated by Clark County, non-profit UMC has never been deterred from its mission despite red-hot competition from several new for-profit hospitals built during the burgeoning growth of the early 2000s. While 10 large hospitals now compete for the local market, the recession has dramatically curtailed that growth‚Ät least one new hospital stands empty today‚Änd further accentuates UMC's charitable role. Each year it admits about 30,000 inpatients and treats nearly 70,000 adult patients in its emergency department and more than half-a-million ambulatory patients.
In keeping with its mission, UMC has focused its 4,000 employees, including 1,550 nurses and 1,400 physicians, on patient-centered care emphasizing quality and patient safety, including core measures, a "patient safety net" system to report medical errors in a non-punitive manner, as well as aggressive infection-control and medication-safety programs.
A key piece of UMC's patient-care strategy is a closed-loop medication management system that uses automated dispensing cabinets and barcode scanning at nursing stations to ensure accurate medication dispensing. Now UMC is advancing that strategy by becoming the first hospital in the nation to adopt software that integrates clinical data from multiple sources and delivers alerts to nurses at their automated medication dispensing cabinets when potential adverse drug reactions are detected.
UMC implemented this unique software in December 2009 on its cardiac care unit (CCU) and cardiovascular care unit (CVCU), where 24 beds support patients with some of the highest needs in the hospital. The innovative system assists clinical pharmacists in identifying patients for adverse clinical events and tracks laboratory results for any changes requiring potential intervention.
Previously, the pharmacy or laboratory identified an adverse event (example: potassium levels being too high), and would place a call to the nurses caring for the patient for corrective action. Now with the Pyxis® Advisor technology, this same information is sent automatically to the automated medication dispensing cabinet on the patient's floor triggering an alert that reports on out-of-range laboratory values. Nurses must respond to each alert before proceeding with medication dispensing for the patient. Through this connectivity, nurses are now getting the same kind of clinical decision support reported through their automated medication dispensing cabinet and nearer to the point of care where it can help nurses most in caring for their patients.
For the rest of the article please visit Patient Safety & Quality Healthcarewww.psqh.com
Ventilator-Associated Pneumonia- Its the Little Things that Count
Making sure that the head of a patient bed is elevated 30% is just one of the important elements for preventing ventilator-associated pneumonia (VAP) in critical care units. It may sound simple to do, but many hospitals still believe that you can judge the elevation strictly by sight, which is not necessarily the case. In fact, at one hospital, when they measured, only 15% of beds were elevated to the appropriate angle.
However, there are some very low or no cost, easy ways to ensure that the patient bed is elevated 30%. For example, one nurse at Stony Brook University Medical Center cut a piece of cardboard in the shape of a slice of pizza, which is now used to measure the elevation of the patient bed. Based on input from staff at Beth Israel Medical Center, a red stripe was placed on each bed by the Engineering Department to ensure accuracy in the elevation of the patient bed.
These and other practical solutions are having a significant impact on preventing and reducing VAP in hospitals. This is merely a sample of the solutions and best practices that were shared by 50 New York hospitals through a statewide collaborative focused on VAP prevention conducted by the Healthcare Association of New York State (HANYS).
As part of its extensive quality and research agenda, HANYS and its member hospitals have been focusing on the prevention of hospital-acquired infections, including VAP. Grant funding from the New York State Department of Health Division of Epidemiology-Hospital Acquired Infection (HAI) Program helped to support a quality improvement collaborative, led by HANYS, called the VAP prevention (VAPP) program.
"After conducting an assessment of our members, we chose VAP because it is a leading cause of death—due to healthcare acquired infection (HAI)—in critical care, and experiences by other national initiatives demonstrated that focused efforts on the VAP bundles could prevent a pneumonia infection, which in turn improves patient care, decreases mortality rates, and lower costs," said Nancy Landor, senior director of HANYS Strategic Quality Initiatives.
"After conducting an assessment of our members, we chose VAP because it is a leading cause of death—due to healthcare acquired infection (HAI)—in critical care, and experiences by other national initiatives demonstrated that focused efforts on the VAP bundles could prevent a pneumonia infection, which in turn improves patient care, decreases mortality rates, and lower costs," said Nancy Landor, senior director of HANYS Strategic Quality Initiatives.
The Collaborative used the Institute for Healthcare Improvement's (IHI's) VAP bundle elements, plus additional elements from the IHI's Critical Care IMPACT Program as the core of improvement activities.
The initiative relied on the hospitals' infection control practitioners for leadership, education, and data. At the end of the first quarter of 2008, the advisory committee set a stretch goal: achieving an overall VAP rate of less than one event per 1,000 ventilator days in the last quarter of 2008.
"Like many stretch goals, it seemed only possible, even only somewhat doable, but we felt it was important for promoting real change," said Landor.
To read the complete article please visit Patient Safety & Quality Healthcare
Addressing Institutional Conflict of Interest to Promote Patient Safety
Studies show that 67% of academic departments have financial relationships with industry (Campbell, 2007b). The Institute of Medicine has warned that academic institutions lack independent review, with resulting tolerance of conflicts due to financial gains, which may pose serious barriers to addressing the issue (IOM, 2009). These financial inducements may result in an emphasis of profits over patient safety (U.S. GAO, 2001).
Such warnings are not theoretical. Institutional forms of conflicts of interest have resulted in institutions and their representatives basing their decisions on financial rewards instead of on an overarching concern for patient safety. The death of teenager Jesse Gelsinger—a clinical study participant at the University of Pennsylvania—highlights these risks.
Addressing institutional conflicts of interest is therefore key to mitigating the risks associated with patient safety. Scrutiny of relationships between industry and academic institutions, as well as establishing internal, independent bodies and policies to improve oversight and intercept conflicts that represent a threat to patient safety must be integrated into systems to avoid tragedies such as the Gelsinger case.
The Jesse Gelsinger Case
Perhaps the most dramatic example of failing to manage institutional conflicts is the death of an 18-year-old study participant, Jesse Gelsinger, in a gene therapy trial at the University of Pennsylvania in 1999 (Rothman 2008). Gelsinger suffered from ornithine transcarbamylase deficiency, which affects the body's ability to eliminate ammonia (Wolf & Lo, 2000). Although potentially life threatening, Geslinger had managed the condition with a strategy of a low-protein diet and medication, and otherwise enjoyed a normal life (Stolberg, 1999). Gelsinger understood that he would not benefit directly from his participation in the Phase I gene therapy study; his decision to participate was motivated by hope that results from the study would avail him of his restrictive diet routine in the future (Wolf & Lo, 2000).
Gelsinger began the study, but almost immediately clinical problems emerged. The evening of his injection with the gene therapy, he experienced a high fever and abdominal pain, and by the next morning, severe hepatic failure and blood clotting. He then lapsed into a coma. His clinical condition rapidly deteriorated, and over the next several days, Geslinger suffered multi-organ failure and, subsequently, brain death. Only 4 days after receiving the gene therapy treatment, he was removed from life support, and died. Jesse Gelsinger's death was then reported to government officials (Stolberg, 1999).
Investigations
Initial investigations by government entities into Gelsinger's death postulated that the genetic therapy vector that was administered to him caused a systemic inflammatory response syndrome. That led to acute respiratory distress syndrome, and eventually his death due to anoxia (Hollon, 2000). These investigations focused on the safety of the adenovirus gene therapy vector, which was used in the gene therapy, and on potential medical error (Stolberg, 1999).
But beyond these components, systems assessments also reviewed broader issues. In this extended analysis, highly troubling revelations of both individual and institutional conflicts of interests existing between investigators and the university and industry began to emerge, leading to more detailed scrutiny of the motivations and judgment exercised by those involved in the trial (Wolf & Lo, 2000).
Several months later, officials from the FDA announced that Gelsinger should never have been a participant in the study due to his clinical condition. Further, the institution's investigators violated FDA requirements by failing to immediately report earlier patients who had experienced serious side effects prior to the Gelsinger study. In addition, informed consent documents provided to participants were altered from that approved by the FDA by omitting important information regarding the death of animal subjects that had undergone similar treatment (Stolberg, 1999).
Yet these FDA discoveries were just the beginning. Upon further review, analyses showed Gelsinger's case was rife with substantive institutional wrongdoing spurred by unmanaged financial conflicts. First, reports submitted by the institution to the FDA, NIH, and IRBs misrepresented the actual clinical findings, and proper disclosures did not occur in the informed consent process (U.S. Department of Justice, 2005). It was also discovered that both the director of the institute leading the research and the University of Pennsylvania itself had significant financial interests in the biotech company that would bring the therapy to market (Rothman, 2008). In fact, both the former dean of the institution's medical school and the lead investigator of the study stood to benefit financially from the commercialization of the therapy through their patent ownership. As well, the academic medical center also had an equity stake in the biotechnology company collaborator, and would have profited from commercialization that would then inure to all of these individuals and institutions (Fox, 2000).
To read the rest of the article please visit Patient Safety & Quality Healthcarewww.psqh.com website
Building a Patient Safety Organization “Field of Dreams” for Emergency Medical Services
For emergency medical service (EMS) providers in the state of Missouri, patient safety organizations are a “field of dreams”—a field of legal protection, learning, collaborating, and most of all, improving pre-hospital care. While many hospitals and other providers are still struggling to fully appreciate the breadth of federal legal protections and other benefits available from working with patient safety organizations (PSO), the Missouri Ambulance Association (MAA) recognized the value months before the final rule was even published. In Missouri, EMS providers—the paramedics, EMTs, and others who respond to 911 calls—have no peer review protection for their quality improvement and patient safety work. Their principal fear was that any well-intentioned efforts at patient safety and quality health care improvement had the potential to be subpoenaed and used against them in legal proceedings. When representatives from the MAA began hearing about the Missouri Center for Patient Safety (MOCPS) and PSOs in general, they paid attention.
It was not for lack of trying that Missouri’s EMS providers had no peer review protections. Since 1996, the MAA had lobbied for nearly 20 different bills, only one of which came close to passing. Ultimately, according to Jason White, consultant for the MAA, the bills were mired in other political agendas, and the pieces related to peer review protection for EMS were always removed. In 2006, Becky Miller, executive director of the MOCPS, was making a series of presentations to various groups around the state to introduce the Center and to provide early education on PSOs. Miller presented to the EMS State Advisory Council in 2006, and got the attention of the late Dr. Bill Jermyn, then EMS medical director for the Missouri Department of Health and Senior Services (DHSS). After hearing Miller speak, Jermyn informed White that working with the PSO might very well be the solution to peer review protection. At the time, the MAA dismissed the idea. They still hoped they would succeed in getting a bill passed, but came to realize 2 years later they needed to search elsewhere for a solution.
For the complete column please visit Patient Safety & Quality Healthcare website.
It was not for lack of trying that Missouri’s EMS providers had no peer review protections. Since 1996, the MAA had lobbied for nearly 20 different bills, only one of which came close to passing. Ultimately, according to Jason White, consultant for the MAA, the bills were mired in other political agendas, and the pieces related to peer review protection for EMS were always removed. In 2006, Becky Miller, executive director of the MOCPS, was making a series of presentations to various groups around the state to introduce the Center and to provide early education on PSOs. Miller presented to the EMS State Advisory Council in 2006, and got the attention of the late Dr. Bill Jermyn, then EMS medical director for the Missouri Department of Health and Senior Services (DHSS). After hearing Miller speak, Jermyn informed White that working with the PSO might very well be the solution to peer review protection. At the time, the MAA dismissed the idea. They still hoped they would succeed in getting a bill passed, but came to realize 2 years later they needed to search elsewhere for a solution.
For the complete column please visit Patient Safety & Quality Healthcare website.
How Patient-Provider Engagement Can Transform Patient Safety
By Dave deBronkart
How would the world change if, suddenly, clinicians had a highly motivated partner in carrying out each care plan? I propose that a new level of patient safety will be possible if we shift to a shared care plan model, with patients and families aware of the plan and engaged in its execution.
I look at healthcare through the lens of a former patient: in 2007 great medicine saved me from Stage IV renal cell carcinoma. But I view it through another lens, too: as a high-tech business person who's watched industries evolve for years, it grips me that this miraculous industry has made so little progress on cost or safety—despite immense efforts by really smart people.
To me, that's a sign we've overlooked something. I assert we're making a fundamental error when we expect clinicians to know and do everything, and we pay a heavy price (literally and figuratively) for this mistake. We should share the load: enlist patients and families in making healthcare better.
The Plausible Promise of Participatory Medicine*
The Society for Participatory Medicine defines this new model as "a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners" (www.ParticipatoryMedicine.org). The Society arose in 2009 out of the "e-patient" concept developed by Tom Ferguson, MD (1944-2006). I joined the movement in 2008 after hearing about it from my physician, Dr. Danny Sands. In this column I write on my own, not on behalf of the Society.
A cornerstone of Ferguson's view is that in today's Internet-enabled world, what's possible in healthcare is radically different from 1990:
* Patients today have access to information that used to be accessible only to clinicians and researchers. That doesn't make them clinicians, but it does show why it's possible for ordinary patients to bring value to the table.
* Today patients can band together in smart communities, sharing experiences and research findings in ways that are inherently patient-centered. (Hospitals work at understanding what patients want; patients know what they want.) This doesn't mean every gathering of patients is inherently smart; it does show how it's possible for patients to aggregate knowledge.
* While patients have access to increased power, clinicians are gripped in a pincer: inexorable pressure to see more patients, while enduring an information explosion. Increasingly, it's impossible for clinicians to keep up. I vetted this point with my oncologist, and he said, "Right—unless you're a sub-sub-specialist like me."
for the rest of column please visit Patient Safety & Quality Healthcare magazine
How would the world change if, suddenly, clinicians had a highly motivated partner in carrying out each care plan? I propose that a new level of patient safety will be possible if we shift to a shared care plan model, with patients and families aware of the plan and engaged in its execution.
I look at healthcare through the lens of a former patient: in 2007 great medicine saved me from Stage IV renal cell carcinoma. But I view it through another lens, too: as a high-tech business person who's watched industries evolve for years, it grips me that this miraculous industry has made so little progress on cost or safety—despite immense efforts by really smart people.
To me, that's a sign we've overlooked something. I assert we're making a fundamental error when we expect clinicians to know and do everything, and we pay a heavy price (literally and figuratively) for this mistake. We should share the load: enlist patients and families in making healthcare better.
The Plausible Promise of Participatory Medicine*
The Society for Participatory Medicine defines this new model as "a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners" (www.ParticipatoryMedicine.org). The Society arose in 2009 out of the "e-patient" concept developed by Tom Ferguson, MD (1944-2006). I joined the movement in 2008 after hearing about it from my physician, Dr. Danny Sands. In this column I write on my own, not on behalf of the Society.
A cornerstone of Ferguson's view is that in today's Internet-enabled world, what's possible in healthcare is radically different from 1990:
* Patients today have access to information that used to be accessible only to clinicians and researchers. That doesn't make them clinicians, but it does show why it's possible for ordinary patients to bring value to the table.
* Today patients can band together in smart communities, sharing experiences and research findings in ways that are inherently patient-centered. (Hospitals work at understanding what patients want; patients know what they want.) This doesn't mean every gathering of patients is inherently smart; it does show how it's possible for patients to aggregate knowledge.
* While patients have access to increased power, clinicians are gripped in a pincer: inexorable pressure to see more patients, while enduring an information explosion. Increasingly, it's impossible for clinicians to keep up. I vetted this point with my oncologist, and he said, "Right—unless you're a sub-sub-specialist like me."
for the rest of column please visit Patient Safety & Quality Healthcare magazine
Friday, November 26, 2010
Study Confirms Passive Patient Safety Devices Are Most Effective in Needlestick Injury Prevention
Bethlehem, Pennsylvania, October 26, 2010—A landmark study of 22 million patient safety devices used in 61 French hospitals over a two-year period has confirmed the theory that passive, fully automatic safety devices offer significantly better protection against accidental needlestick injuries (NSIs) than early generation active patient safety technologies such as semi-automatic (push-button) devices or those with manually sliding shields or hinged caps.
This study, described in the article “Needlestick Injury Rates According to Different Types of Safety-Engineered Devices: Results of a French Multicenter Study” in the April 2010 issue of Infection Control and Hospital Epidemiology, was the first head-to-head comparison of safety-engineered devices by safety technology type. It was conducted by GERES (Groupe d’Etude sur le Risque d’Exposition des Soignants), a well-established, government-funded research group.
The study concludes that passive safety engineered devices are more effective than active devices for NSI prevention.
Among its findings, the study documents the procedure specific needlestick injury rate by safety device technology. For intravascular catheters the NSI rate for passive or fully automatic devices studied was 1.31 per 100,000 devices used, compared with 2.54 per 100,000 devices used for semi-automatic (push-button) technology and 4.34 per 100,000 devices used for manually sliding shield technology. With semi-automatic and sliding shield devices, healthcare workers can choose whether or not to operate the safety features. Passive, fully automatic devices, on the other hand, “require no input from the user” and “eliminate the need for elaborate training.” According to the study, fully automatic or passive safety devices are most effective for NSI prevention. The B. Braun Medical Inc. (B. Braun) Introcan Safety® IV Catheter was one of the devices used in this study and is a market share leader in fully automatic, passive safety technology IV catheters.
“Automatic safety features in catheters are critical to reducing accidental needlestick injuries,” said Lynn Hadaway, M.Ed., RN, BC, CRNI, who has more than 35 years experience in infusion nursing and adult education. “The study clearly demonstrates why healthcare facilities need to carefully select devices on the basis of their passive safety features.” Hadaway recently recorded her thoughts on the significance of this study and that video can be accessed here.
Janine Jagger, director of the International Healthcare Workers Safety Center at the University of Virginia, said the study “may never be replicated because of its sheer size – involving 22 million needle devices.”
“The researchers have demonstrated that devices requiring the least manipulation to cover the needles have the lowest injury rates - passive devices being the lowest,” she said. “This is the same phenomenon that was first demonstrated more than 20 years ago, but with comparisons at that time to conventional needles. The technological advances since then have been amazing. We should not forget that all of these safety designs are significantly safer than conventional needles.”
“This study adds a critical new layer of evidence supporting the adoption and use of safety engineered devices to prevent healthcare worker injuries and exposure to blood borne pathogens like hepatitis C and HIV. It provides conclusive evidence of the increased protection fully automatic devices provide when compared with other early generation safety-engineered devices,” said Tom Sutton, Vice President, Vascular Access and IV Systems for B. Braun Medical Inc. “The study shows a passive, fully automatic safety IV catheter is about two times better than an active, semi-automatic ’push-button’ safety shield and three times better than a manually sliding shield technology in preventing NSIs.”
With B. Braun’s Introcan Safety® IV Catheter, for example, all the user has to do is use it, as the safety mechanism does not require any extra steps for activation. There is no risk of forgetting to make the needle safe. From insertion to advancing the catheter to needle removal, clinicians are protected because they are using a fully automatic passive safety device that cannot be bypassed.
Sutton added that the GERES study is likely to influence purchasing trends as healthcare professionals evaluate the most appropriate devices for their facilities.
For more information or a copy of the study, click here.
About B. Braun
B. Braun is a leading manufacturer of infusion therapy and pain management products with an environmentally-friendly focus. Guided by the company’s “Sharing Expertise®” philosophy, B. Braun addresses the critical issues of infection prevention, medication safety and environmental responsibility by promoting best practices that help clinicians reduce medication errors, prevent healthcare-acquired infections (HAIs) and achieve sustainability objectives.
Consistently recognized by Frost & Sullivan and KLAS for its medical technology and support services, B. Braun employees share their knowledge with colleagues and customers to improve working processes in hospitals and medical practices and to enhance the safety of patients and healthcare professionals. For more information, call 800-227-2862, email us at inquiry.us@bbraun.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit B. Braun at www.bbraunusa.com.
This study, described in the article “Needlestick Injury Rates According to Different Types of Safety-Engineered Devices: Results of a French Multicenter Study” in the April 2010 issue of Infection Control and Hospital Epidemiology, was the first head-to-head comparison of safety-engineered devices by safety technology type. It was conducted by GERES (Groupe d’Etude sur le Risque d’Exposition des Soignants), a well-established, government-funded research group.
The study concludes that passive safety engineered devices are more effective than active devices for NSI prevention.
Among its findings, the study documents the procedure specific needlestick injury rate by safety device technology. For intravascular catheters the NSI rate for passive or fully automatic devices studied was 1.31 per 100,000 devices used, compared with 2.54 per 100,000 devices used for semi-automatic (push-button) technology and 4.34 per 100,000 devices used for manually sliding shield technology. With semi-automatic and sliding shield devices, healthcare workers can choose whether or not to operate the safety features. Passive, fully automatic devices, on the other hand, “require no input from the user” and “eliminate the need for elaborate training.” According to the study, fully automatic or passive safety devices are most effective for NSI prevention. The B. Braun Medical Inc. (B. Braun) Introcan Safety® IV Catheter was one of the devices used in this study and is a market share leader in fully automatic, passive safety technology IV catheters.
“Automatic safety features in catheters are critical to reducing accidental needlestick injuries,” said Lynn Hadaway, M.Ed., RN, BC, CRNI, who has more than 35 years experience in infusion nursing and adult education. “The study clearly demonstrates why healthcare facilities need to carefully select devices on the basis of their passive safety features.” Hadaway recently recorded her thoughts on the significance of this study and that video can be accessed here.
Janine Jagger, director of the International Healthcare Workers Safety Center at the University of Virginia, said the study “may never be replicated because of its sheer size – involving 22 million needle devices.”
“The researchers have demonstrated that devices requiring the least manipulation to cover the needles have the lowest injury rates - passive devices being the lowest,” she said. “This is the same phenomenon that was first demonstrated more than 20 years ago, but with comparisons at that time to conventional needles. The technological advances since then have been amazing. We should not forget that all of these safety designs are significantly safer than conventional needles.”
“This study adds a critical new layer of evidence supporting the adoption and use of safety engineered devices to prevent healthcare worker injuries and exposure to blood borne pathogens like hepatitis C and HIV. It provides conclusive evidence of the increased protection fully automatic devices provide when compared with other early generation safety-engineered devices,” said Tom Sutton, Vice President, Vascular Access and IV Systems for B. Braun Medical Inc. “The study shows a passive, fully automatic safety IV catheter is about two times better than an active, semi-automatic ’push-button’ safety shield and three times better than a manually sliding shield technology in preventing NSIs.”
With B. Braun’s Introcan Safety® IV Catheter, for example, all the user has to do is use it, as the safety mechanism does not require any extra steps for activation. There is no risk of forgetting to make the needle safe. From insertion to advancing the catheter to needle removal, clinicians are protected because they are using a fully automatic passive safety device that cannot be bypassed.
Sutton added that the GERES study is likely to influence purchasing trends as healthcare professionals evaluate the most appropriate devices for their facilities.
For more information or a copy of the study, click here.
About B. Braun
B. Braun is a leading manufacturer of infusion therapy and pain management products with an environmentally-friendly focus. Guided by the company’s “Sharing Expertise®” philosophy, B. Braun addresses the critical issues of infection prevention, medication safety and environmental responsibility by promoting best practices that help clinicians reduce medication errors, prevent healthcare-acquired infections (HAIs) and achieve sustainability objectives.
Consistently recognized by Frost & Sullivan and KLAS for its medical technology and support services, B. Braun employees share their knowledge with colleagues and customers to improve working processes in hospitals and medical practices and to enhance the safety of patients and healthcare professionals. For more information, call 800-227-2862, email us at inquiry.us@bbraun.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit B. Braun at www.bbraunusa.com.
Training Important for Patient Safety Improvement
Chicago, Illinois, October 19, 2010—Hospitals that had operating room personnel participate in a medical team training program that incorporates practices of aviation crews, such as training in teamwork and communication, had a lower rate of surgical deaths compared to hospitals that did not participate in the program, according to a study in the October 20 issue of JAMA.
Adverse events related to surgery continue to occur despite the best efforts of clinicians, according to background information in the article. In 2006, the Veterans Health Administration (VHA), the largest national integrated health care system in the United States, with 130 hospitals that provide surgical services, implemented a nationwide Medical Team Training program, which includes 2 months of preparation and planning with each facility's implementation surgical care team. “This is followed by a day-long onsite learning session,” the authors write. “Using the crew resource management theory from aviation adapted for health care, clinicians were trained to work as a team; challenge each other when they identify patient safety risks; conduct checklist-guided preoperative briefings and postoperative debriefings; and implement other communication strategies such as recognizing red flags, rules of conduct for communication, stepping back to reassess a situation, and how to conduct effective communication between clinicians during care transitions.”
Julia Neily, R.N., M.S., M.P.H., of the National Center for Patient Safety, Department of Veterans Affairs, Hanover, N.H., and colleagues analyzed surgical mortality for facilities that received the VHA training program compared with those that had not received it. Outcome data were obtained from the VHA Surgical Quality Improvement Program and from structured interviews in fiscal years 2006 to 2008. The analysis included 182,409 sampled procedures from 108 VHA facilities that provided care to veterans.
The risk-adjusted mortality rates at the beginning of the study were 17 per 1,000 procedures per year for the trained facilities and 15 per 1,000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1,000 procedures per year for both groups. “After controlling for baseline differences, the 74 trained facilities experienced a significant decrease of 18 percent in observed mortality. Mortality decreased by 7 percent in the nontrained facilities,” the researchers note. Analysis indicated an almost 50 percent greater decrease in the annual surgical mortality rate in the trained group than in the nontrained group.
After adjusting for surgical risk and volume, the researchers also found that for every quarter of training, the mortality rate decreased 0.5 per 1,000 procedure deaths. And for every increase in the degree of briefing and debriefings at the facilities, the mortality rate was reduced by 0.6 per 1,000 procedures.
“It is our hypothesis that conducting preoperative briefings is a key component in reducing mortality because it provides a final chance to correct problems before starting the case. The use of conducting briefings and debriefings requires a more active participation and involvement than sometimes occurs when a checklist is used by itself. During follow-up interviews, facilities provided specific examples of having avoided adverse events because of the briefing,” the authors write. They add that teams also shared the value of voicing problems in the debriefing and that resolving issues in a timely manner was an improvement attributable to the team training program.
Adverse events related to surgery continue to occur despite the best efforts of clinicians, according to background information in the article. In 2006, the Veterans Health Administration (VHA), the largest national integrated health care system in the United States, with 130 hospitals that provide surgical services, implemented a nationwide Medical Team Training program, which includes 2 months of preparation and planning with each facility's implementation surgical care team. “This is followed by a day-long onsite learning session,” the authors write. “Using the crew resource management theory from aviation adapted for health care, clinicians were trained to work as a team; challenge each other when they identify patient safety risks; conduct checklist-guided preoperative briefings and postoperative debriefings; and implement other communication strategies such as recognizing red flags, rules of conduct for communication, stepping back to reassess a situation, and how to conduct effective communication between clinicians during care transitions.”
Julia Neily, R.N., M.S., M.P.H., of the National Center for Patient Safety, Department of Veterans Affairs, Hanover, N.H., and colleagues analyzed surgical mortality for facilities that received the VHA training program compared with those that had not received it. Outcome data were obtained from the VHA Surgical Quality Improvement Program and from structured interviews in fiscal years 2006 to 2008. The analysis included 182,409 sampled procedures from 108 VHA facilities that provided care to veterans.
The risk-adjusted mortality rates at the beginning of the study were 17 per 1,000 procedures per year for the trained facilities and 15 per 1,000 procedures per year for the nontrained facilities. At the end of the study, the rates were 14 per 1,000 procedures per year for both groups. “After controlling for baseline differences, the 74 trained facilities experienced a significant decrease of 18 percent in observed mortality. Mortality decreased by 7 percent in the nontrained facilities,” the researchers note. Analysis indicated an almost 50 percent greater decrease in the annual surgical mortality rate in the trained group than in the nontrained group.
After adjusting for surgical risk and volume, the researchers also found that for every quarter of training, the mortality rate decreased 0.5 per 1,000 procedure deaths. And for every increase in the degree of briefing and debriefings at the facilities, the mortality rate was reduced by 0.6 per 1,000 procedures.
“It is our hypothesis that conducting preoperative briefings is a key component in reducing mortality because it provides a final chance to correct problems before starting the case. The use of conducting briefings and debriefings requires a more active participation and involvement than sometimes occurs when a checklist is used by itself. During follow-up interviews, facilities provided specific examples of having avoided adverse events because of the briefing,” the authors write. They add that teams also shared the value of voicing problems in the debriefing and that resolving issues in a timely manner was an improvement attributable to the team training program.
Fortify HIT Contracts with Education and Ethics to Protect Patient Safety, Say Informatics Experts
Washington, D.C., November 11, 2010—An original and progressive report on health information technology (HIT) vendors, their customers and patients, published online, makes ground-breaking recommendations for new practices that target the reduction or elimination of tensions that currently mar relationships between many HIT vendors and their customers, specifically with regard to indemnity and error management of HIT systems. In light of the Obama Administration's $19 billion investment in HIT, paid out in ARRA stimulus funds, these recommendations are particularly significant in helping to foster greater use of electronic health records and other tools in the transition from paper records, largely understood to be a hindrance to quality patient care.
The recommendations, adopted by AMIA -- the association of informatics professionals and a trusted authority in the HIT community -- strive to imbue the HIT vendor-customer relationship with transparency, veracity, and accountability through collaborative education focused on the installation, configuration and use of HIT systems, in combination with enterprise-wide ethics education to support patient safety. The recommendations are the result of deliberations by an AMIA Board-appointed Task Force. The position statement will appear in the January/February 2011 print edition of JAMIA, the scholarly peer-reviewed journal of informatics in health and biomedicine, co-published by AMIA and the BMJ Group.
"There was a need to consider, study and analyze questions of appropriate oversight," said AMIA Board Chairwoman Nancy M. Lorenzi, PhD, Assistant Vice Chancellor for Health Affairs and Professor of Biomedical Informatics, Vanderbilt University. "With as much interest and investment in HIT as there is today, AMIA -- an unbiased third party -- wanted to take a fresh look at gray areas that currently exist between vendors and their customers to see where new practices could be implemented to better support patient outcomes and protect patients, who these systems ultimately serve. We think these recommendations do an excellent job of addressing fairness and balancing accountability in the HIT marketplace and in the health sector."
The report, titled "HIT Vendors, their customers and patients: New challenges in ethics, safety, best practices and oversight," makes specific recommendations on Contract Language, Education and Ethics, Ethical Standards, User Groups, Best Practices, and Marketing. An additional section addresses Regulation and Oversight of the HIT Industry and next steps.
The report's first author is Kenneth W. Goodman, PhD, FACMI, director of the University of Miami Bioethics Program. Dr. Goodman chaired the Task Force responsible for the report, a group of AMIA members comprising nationwide representatives of academia, industry, and leading healthcare institutions.
"AMIA provided an important forum in which complex and sometimes conflicting positions were candidly discussed, analyzed and balanced," said Dr. Goodman. "HIT systems are ubiquitous these days and need better oversight. These recommendations demonstrate a high-value commitment to patient safety, quality care, and innovation -- healthcare goals sometimes difficult to reconcile. These recommendations," he added, "can help individual institutions do more to support successful HIT implementation."
Among the recommendations is contract language specified to protect patient safety and to spell out the shared responsibility that vendors and their customers have for successful implementation. "Hold harmless" clauses in contracts between vendors and purchasers or clinical users, that absolve vendors for errors or defects in their software, are declared unethical by AMIA.
The AMIA position states that "safe and successful HIT systems further require ethics education, which has become a standard part of professional development in the corporate world." HIT vendors and their clients are urged to adopt enterprise-wide ethics education to parallel what accrediting healthcare organizations require. Standards for corporate conduct and subsequent education about such standards are also recommended. A variety of informational tools, many aimed for post-market use, are cited among best practices to assist institutions and clinical practices in achieving optimal HIT implementation.
AMIA President and CEO Edward H. Shortliffe, MD, PhD, praised the Task Force and its accomplishment. "This group of informatics and industry leaders recognized the need to meld business ethics into successful adoption of HIT. Their recommendations balance the forces that drive the competitive HIT marketplace with the practical needs of clinicians, patients, researchers, public health workers and officials. AMIA stands by their work and hopes these recommendations will be embraced by the HIT community."
Full text of the AMIA position on HIT vendors, their customers and patients is available online at www.jamia.org as an open-access document. Its co-authors are Eta Berner, EdD, FACMI, professor of health informatics at University of Alabama at Birmingham; Mark A. Dente, MD, GE Healthcare IT; Bonnie Kaplan, PhD, FACMI, lecturer at Yale University School of Medicine, and Bioethics Center Scholar at the Interdisciplinary Center for Bioethics at Yale's Institution for Social and Policy Studies; Ross Koppel, PhD, professor in the Sociology Department and in School of Medicine at University of Pennsylvania; Donald Rucker, MD, vice president and chief medical officer at Siemens Healthcare U.S.A.; Daniel Z. Sands, MD, MPH, FACMI, director of medical informatics at Cisco Internet Business Solutions Group, and clinical assistant professor of medicine at Harvard Medical School; and Peter Winkelstein, MD, MBA, chief of the Division of General Pediatrics at Women & Children's Hospital of Buffalo, and chief medical informatics officer at UB/MD, the University of Buffalo Physicians Group.
AMIA, the leading professional association for informatics professionals, serves as the voice of the nation's top biomedical and health informatics professionals and plays an important role in medicine, health care, and science, encouraging the use of data, information and knowledge to improve both human health and delivery of healthcare services.
The recommendations, adopted by AMIA -- the association of informatics professionals and a trusted authority in the HIT community -- strive to imbue the HIT vendor-customer relationship with transparency, veracity, and accountability through collaborative education focused on the installation, configuration and use of HIT systems, in combination with enterprise-wide ethics education to support patient safety. The recommendations are the result of deliberations by an AMIA Board-appointed Task Force. The position statement will appear in the January/February 2011 print edition of JAMIA, the scholarly peer-reviewed journal of informatics in health and biomedicine, co-published by AMIA and the BMJ Group.
"There was a need to consider, study and analyze questions of appropriate oversight," said AMIA Board Chairwoman Nancy M. Lorenzi, PhD, Assistant Vice Chancellor for Health Affairs and Professor of Biomedical Informatics, Vanderbilt University. "With as much interest and investment in HIT as there is today, AMIA -- an unbiased third party -- wanted to take a fresh look at gray areas that currently exist between vendors and their customers to see where new practices could be implemented to better support patient outcomes and protect patients, who these systems ultimately serve. We think these recommendations do an excellent job of addressing fairness and balancing accountability in the HIT marketplace and in the health sector."
The report, titled "HIT Vendors, their customers and patients: New challenges in ethics, safety, best practices and oversight," makes specific recommendations on Contract Language, Education and Ethics, Ethical Standards, User Groups, Best Practices, and Marketing. An additional section addresses Regulation and Oversight of the HIT Industry and next steps.
The report's first author is Kenneth W. Goodman, PhD, FACMI, director of the University of Miami Bioethics Program. Dr. Goodman chaired the Task Force responsible for the report, a group of AMIA members comprising nationwide representatives of academia, industry, and leading healthcare institutions.
"AMIA provided an important forum in which complex and sometimes conflicting positions were candidly discussed, analyzed and balanced," said Dr. Goodman. "HIT systems are ubiquitous these days and need better oversight. These recommendations demonstrate a high-value commitment to patient safety, quality care, and innovation -- healthcare goals sometimes difficult to reconcile. These recommendations," he added, "can help individual institutions do more to support successful HIT implementation."
Among the recommendations is contract language specified to protect patient safety and to spell out the shared responsibility that vendors and their customers have for successful implementation. "Hold harmless" clauses in contracts between vendors and purchasers or clinical users, that absolve vendors for errors or defects in their software, are declared unethical by AMIA.
The AMIA position states that "safe and successful HIT systems further require ethics education, which has become a standard part of professional development in the corporate world." HIT vendors and their clients are urged to adopt enterprise-wide ethics education to parallel what accrediting healthcare organizations require. Standards for corporate conduct and subsequent education about such standards are also recommended. A variety of informational tools, many aimed for post-market use, are cited among best practices to assist institutions and clinical practices in achieving optimal HIT implementation.
AMIA President and CEO Edward H. Shortliffe, MD, PhD, praised the Task Force and its accomplishment. "This group of informatics and industry leaders recognized the need to meld business ethics into successful adoption of HIT. Their recommendations balance the forces that drive the competitive HIT marketplace with the practical needs of clinicians, patients, researchers, public health workers and officials. AMIA stands by their work and hopes these recommendations will be embraced by the HIT community."
Full text of the AMIA position on HIT vendors, their customers and patients is available online at www.jamia.org as an open-access document. Its co-authors are Eta Berner, EdD, FACMI, professor of health informatics at University of Alabama at Birmingham; Mark A. Dente, MD, GE Healthcare IT; Bonnie Kaplan, PhD, FACMI, lecturer at Yale University School of Medicine, and Bioethics Center Scholar at the Interdisciplinary Center for Bioethics at Yale's Institution for Social and Policy Studies; Ross Koppel, PhD, professor in the Sociology Department and in School of Medicine at University of Pennsylvania; Donald Rucker, MD, vice president and chief medical officer at Siemens Healthcare U.S.A.; Daniel Z. Sands, MD, MPH, FACMI, director of medical informatics at Cisco Internet Business Solutions Group, and clinical assistant professor of medicine at Harvard Medical School; and Peter Winkelstein, MD, MBA, chief of the Division of General Pediatrics at Women & Children's Hospital of Buffalo, and chief medical informatics officer at UB/MD, the University of Buffalo Physicians Group.
AMIA, the leading professional association for informatics professionals, serves as the voice of the nation's top biomedical and health informatics professionals and plays an important role in medicine, health care, and science, encouraging the use of data, information and knowledge to improve both human health and delivery of healthcare services.
CareChex Releases new Study On Quality Of Healthcare at University Hospitals
Greenville, South Carolina, November 1, 2010—CareChex, a division of The Delta Group specializing in rating the quality of hospital and physician care, released a new study, An Assessment of the Quality of University Hospital Care in the U.S., that investigates whether or not university hospitals outperform other hospitals on objective measures of quality. Importantly, to accurately assess the relative quality of care provided by university hospitals, the study removed unusually difficult cases (i.e., outliers) and adjusted for differences in patient risk factors (i.e., clinical and demographic characteristics).
Study results were surprising: While university hospitals do very well as a group in cancer care and in overall medical care, in many clinical categories they either performed the same as non-university hospitals or sometimes far worse. For example, 89% of university hospitals fall below the national average in orthopedic care, and 85% fall below the national average for general surgery.
CareChex looked across all key components of quality available for comparison – process, outcomes, and patient satisfaction – to form a single composite percentile score and attendant quality ranking. A total of 118 university hospitals were evaluated using The Delta Group’s National Quality Rating Database (NQRD), which includes virtually all general, acute, non-federal U.S. hospitals.
"Most people assume that a university hospital will provide better quality health care because these institutions typically conduct cutting-edge academic research, have lofty reputations and adopt the latest treatment protocols and technologies," says Dr. Thane Forthman, Managing Principal of The Delta Group. “We were especially surprised to see the study reveal that some of the nation’s best-known university hospitals scored in the bottom quartile of all hospitals nationally for overall quality of hospital care.”
“Certainly more research is needed, but at university hospitals you have a large population of interns and residents who are still being trained. While under the supervision of an attending physician, they have the autonomy to make rounds, order lab tests and make clinical decisions, even though they lack time-tested, hands-on experience,” says Forthman.
“More importantly, interns and residents often work extended shifts of up to 80 hours per week, which empirical research has shown dramatically increases fatigue-related medical and diagnostic errors, medication errors and other adverse events.”
“Regardless of the potential factors contributing to the issue, patients should consider the quality of care provided by all hospitals in their market before making the assumption that a university hospital will provide superior care.”
Among the key CareChex study findings:
* University hospitals appeared more frequently in the top 10% of all hospitals nationally in cancer care and overall medical care: 43% of university hospitals studied performed in the top 10% nationally for cancer care, while 17% performed in the top 10% for overall medical care.
* Surprisingly, many highly-regarded university hospitals performed in the bottom 25% of all hospitals nationally for overall quality of hospital care, including: Emory University Hospital, Dartmouth-Hitchcock Memorial Hospital, George Washington University Hospital, Georgetown University Hospital, Hospital of University of Pennsylvania, Stanford Hospital, Shands Hospital at the University of Florida, The Johns Hopkins Hospital, The University of Chicago Medical Center and University of North Carolina Hospital (Chapel Hill).
* Of the 118 university hospitals evaluated, 17 were in the top 10% of all hospitals nationally for overall quality of care in three or more clinical categories:
Study results were surprising: While university hospitals do very well as a group in cancer care and in overall medical care, in many clinical categories they either performed the same as non-university hospitals or sometimes far worse. For example, 89% of university hospitals fall below the national average in orthopedic care, and 85% fall below the national average for general surgery.
CareChex looked across all key components of quality available for comparison – process, outcomes, and patient satisfaction – to form a single composite percentile score and attendant quality ranking. A total of 118 university hospitals were evaluated using The Delta Group’s National Quality Rating Database (NQRD), which includes virtually all general, acute, non-federal U.S. hospitals.
"Most people assume that a university hospital will provide better quality health care because these institutions typically conduct cutting-edge academic research, have lofty reputations and adopt the latest treatment protocols and technologies," says Dr. Thane Forthman, Managing Principal of The Delta Group. “We were especially surprised to see the study reveal that some of the nation’s best-known university hospitals scored in the bottom quartile of all hospitals nationally for overall quality of hospital care.”
“Certainly more research is needed, but at university hospitals you have a large population of interns and residents who are still being trained. While under the supervision of an attending physician, they have the autonomy to make rounds, order lab tests and make clinical decisions, even though they lack time-tested, hands-on experience,” says Forthman.
“More importantly, interns and residents often work extended shifts of up to 80 hours per week, which empirical research has shown dramatically increases fatigue-related medical and diagnostic errors, medication errors and other adverse events.”
“Regardless of the potential factors contributing to the issue, patients should consider the quality of care provided by all hospitals in their market before making the assumption that a university hospital will provide superior care.”
Among the key CareChex study findings:
* University hospitals appeared more frequently in the top 10% of all hospitals nationally in cancer care and overall medical care: 43% of university hospitals studied performed in the top 10% nationally for cancer care, while 17% performed in the top 10% for overall medical care.
* Surprisingly, many highly-regarded university hospitals performed in the bottom 25% of all hospitals nationally for overall quality of hospital care, including: Emory University Hospital, Dartmouth-Hitchcock Memorial Hospital, George Washington University Hospital, Georgetown University Hospital, Hospital of University of Pennsylvania, Stanford Hospital, Shands Hospital at the University of Florida, The Johns Hopkins Hospital, The University of Chicago Medical Center and University of North Carolina Hospital (Chapel Hill).
* Of the 118 university hospitals evaluated, 17 were in the top 10% of all hospitals nationally for overall quality of care in three or more clinical categories:
An Exciting Appointment to Head CMS
This is a choice that exceeds Moynihan’s rareness of competency. Berwick represents the ideal, the one person you think could help the government, the people, and the medical profession come together and coalesce around the idea of excellent healthcare. Last December at the Institute for Healthcare Improvement conference, I watched hundreds of professionals cheer on Berwick as they would a rock star. This is a doctor who’s willing to talk about what’s really important to people. “Healthcare has no intrinsic value at all. None; health does. Joy does. Peace does,” he said in December. “The best hospital bed is empty. The best CT scan is the one we don’t need. The best doctor’s visit is the one we don’t need.”
Imagine that. Doctors we don’t need.
That notion is far removed from the politics of healthcare reform. The debate in Washington is about the role of government or insurance. It’s not about capturing bliss.
Our current system is not designed to empty hospital beds. Our reward system — dare I say, the very foundation of free enterprise — works best when hospital beds are full, CT scanners are humming, and doctor visits are available on demand. That’s even true in government and the Indian Health Service because the appropriations process does not pay for those patients not requiring treatment. Yet that very idea, a paradox, is what could lower health care costs for all.
Berwick said it’s our version of the Tragedy of the Commons. The 1968 article in Science by Garrett Hardin described a pasture open to all that works reasonably well until “a day of reckoning, that is, the day when the long-desired goal of social stability becomes a reality. At this point, the inherent logic of the commons remorselessly generates tragedy.” The commons no longer works because each of us seeks the best deal for ourselves.
“Name any stakeholder — hospital, physician, nurse, insurer, pharmaceutical manufacturer, supplier, even patients’ group — every single one of them says, “Oh, we need change! We need change!” But, when it comes to specifics, every single one of them demands to be kept whole or made better off,” Berwick said. “So everybody draws on the Commons, the herds grow, and the Commons fails. If you don’t increase your herd, you’re a chump. And, who wants to be a chump?”
Let’s make being a chump a good thing. The fact is the spirit of cooperation is already driving down medical costs in places as diverse as Anchorage with the Southcentral Foundation, Alaska Native Medical Center, and Cedar Rapids, Iowa. Indeed, the great thing about the Indian Health System is a head start in this regard. There is a long history of consultation — doctors and government officials working together with tribal leaders — for common solutions (and with little money). The Indian Health Service invented a prevention bundle — a series of tests — that look at many aspects of a patient’s life that helps identity and then treat problems ranging from spousal abuse to depression.
“I challenge us to end the Tragedy of the Commons in health care. I challenge us to prove Garrett Hardin wrong,” Berwick said. “It isn’t easy. Positive collective action, even in small communities, and especially in healthcare, is fragile. It could all just fall apart. But, it can work. I know it can work because, sometimes, some places, it does work.”
Forget healthcare reform. Let’s shoot for what we really, really want. But if we seek bliss, that means we must get folks working together.
Imagine that. Doctors we don’t need.
That notion is far removed from the politics of healthcare reform. The debate in Washington is about the role of government or insurance. It’s not about capturing bliss.
Our current system is not designed to empty hospital beds. Our reward system — dare I say, the very foundation of free enterprise — works best when hospital beds are full, CT scanners are humming, and doctor visits are available on demand. That’s even true in government and the Indian Health Service because the appropriations process does not pay for those patients not requiring treatment. Yet that very idea, a paradox, is what could lower health care costs for all.
Berwick said it’s our version of the Tragedy of the Commons. The 1968 article in Science by Garrett Hardin described a pasture open to all that works reasonably well until “a day of reckoning, that is, the day when the long-desired goal of social stability becomes a reality. At this point, the inherent logic of the commons remorselessly generates tragedy.” The commons no longer works because each of us seeks the best deal for ourselves.
“Name any stakeholder — hospital, physician, nurse, insurer, pharmaceutical manufacturer, supplier, even patients’ group — every single one of them says, “Oh, we need change! We need change!” But, when it comes to specifics, every single one of them demands to be kept whole or made better off,” Berwick said. “So everybody draws on the Commons, the herds grow, and the Commons fails. If you don’t increase your herd, you’re a chump. And, who wants to be a chump?”
Let’s make being a chump a good thing. The fact is the spirit of cooperation is already driving down medical costs in places as diverse as Anchorage with the Southcentral Foundation, Alaska Native Medical Center, and Cedar Rapids, Iowa. Indeed, the great thing about the Indian Health System is a head start in this regard. There is a long history of consultation — doctors and government officials working together with tribal leaders — for common solutions (and with little money). The Indian Health Service invented a prevention bundle — a series of tests — that look at many aspects of a patient’s life that helps identity and then treat problems ranging from spousal abuse to depression.
“I challenge us to end the Tragedy of the Commons in health care. I challenge us to prove Garrett Hardin wrong,” Berwick said. “It isn’t easy. Positive collective action, even in small communities, and especially in healthcare, is fragile. It could all just fall apart. But, it can work. I know it can work because, sometimes, some places, it does work.”
Forget healthcare reform. Let’s shoot for what we really, really want. But if we seek bliss, that means we must get folks working together.
New Manual For Medical Malpractice Lawsuits
How to Survive a Medical Malpractice Lawsuit is a manual intended to demystify what one can expect when named as a defendant in a malpractice claim. Given the likelihood that a physician practicing in the U.S. will be sued at some point in his/her career – especially those in “high risk” specialties – this book should have broad appeal in the medical community. The author, Ilene Brenner, is a practicing physician who offers pragmatic strategies that she found helpful based on personal experience as a malpractice defendant. She augments what she learned with legal knowhow from a seasoned malpractice defense lawyer – her father.
The book provides a detailed description of the convoluted twists and turns that a malpractice claim may take. It follows the chronological steps of a claim, beginning with the defendant being served legal notice. Each phase, its associated legal terms, procedures and potential outcomes are concisely explained. Key process steps (i.e. jury selection, expert witness selection and testimony, decision-making regarding whether to settle or go to trial) are summarized, embellished with pertinent questions or options that may warrant exploring.
The difference between a “claims-made” and an “occurrence” professional liability insurance policy is explained, as well as the importance of promptly notifying the insurance carrier of both formally-asserted claims and cases a clinician believes may lead to a claim in the future. The meaning and usefulness of key policy terms, such as the “consent to settle” clause, are also described. The author also makes of point of describing how a defendant can recognize if his/her interests are being effectively protected by the carrier’s assigned claim adjuster and the appointed defense lawyer, and steps to take if indicated.
Dr. Brenner allots considerable space to explaining how to prepare for and comport oneself when giving a deposition, testifying in court, and while sitting at the defense table during a trial. Examples of cases in which otherwise defensible claims have been lost because of poor preparation or ill-advised courtroom behavior emphasize the importance of those strategies. Realistic lines of inquiry by plaintiff lawyers during a deposition or trial are cited, as a basis for offering tips on how to frame one’s answers in a constructive manner. Commentary is also offered on highly specific topics that may be overlooked in similar texts, such as when it is imprudent to research the clinical practice issues involved with the case. The emotional impact of being sued is also addressed, with a number of coping strategies offered the author found useful.
Though understandable, the author’s antipathy for plaintiff lawyers and “hired gun” plaintiff experts is transparent and a bit off-putting. Her admonition to never discuss a case involving an unanticipated event with a hospital representative unless represented by legal counsel – while well intended – appears to impute bad faith to all individuals charged with such investigations. Moreover, there is no mention of a hospital’s duty to perform a thorough, multidisciplinary, root cause analysis (RCA) of cases that meet The Joint Commission’s definition of a sentinel event. When physicians are unwilling to candidly share their perspective during such reviews, the hospital’s ability to identify and implement patient safety improvements is significantly constrained.
Following the content highlighted above, practical strategies to reduce the likelihood of being sued are also offered. Topics include (but are not limited to): informed consent and refusal, medical record documentation, effective communication, and the risk of keeping “personal notes.” Because such practices are only touched on, readers should exercise caution when applying such advice in a specific case; to do so could be problematic. For instance, the section pertaining to patients leaving against medical advice (AMA) advises that if the patients are determined to be impaired, mentally incompetent, and unable to make a proper decision for their care “you cannot allow them to leave the hospital AMA.” It would have been useful to have explained that unless such detentions are carried out in strict conformance with applicable statutes, individuals held against their wishes could allege “false imprisonment.” Emphasizing the benefit of obtaining case-specific, concurrent legal advice would also have been helpful.
The book’s engaging style and relative brevity (136 pages) make it an easy read. The comprehensive glossary also promotes understanding of obtuse legal terms. Differences in states’ statutes in regard to: alternative dispute resolution practices, recognition of collateral payment sources, and the so-called “I’m sorry” laws are outlined in the appendices. Persons most likely to benefit from reading this book include: medical staff leaders, physicians, residents, advanced practice professionals, and those involved in claim management.
Anne Irving
The book provides a detailed description of the convoluted twists and turns that a malpractice claim may take. It follows the chronological steps of a claim, beginning with the defendant being served legal notice. Each phase, its associated legal terms, procedures and potential outcomes are concisely explained. Key process steps (i.e. jury selection, expert witness selection and testimony, decision-making regarding whether to settle or go to trial) are summarized, embellished with pertinent questions or options that may warrant exploring.
The difference between a “claims-made” and an “occurrence” professional liability insurance policy is explained, as well as the importance of promptly notifying the insurance carrier of both formally-asserted claims and cases a clinician believes may lead to a claim in the future. The meaning and usefulness of key policy terms, such as the “consent to settle” clause, are also described. The author also makes of point of describing how a defendant can recognize if his/her interests are being effectively protected by the carrier’s assigned claim adjuster and the appointed defense lawyer, and steps to take if indicated.
Dr. Brenner allots considerable space to explaining how to prepare for and comport oneself when giving a deposition, testifying in court, and while sitting at the defense table during a trial. Examples of cases in which otherwise defensible claims have been lost because of poor preparation or ill-advised courtroom behavior emphasize the importance of those strategies. Realistic lines of inquiry by plaintiff lawyers during a deposition or trial are cited, as a basis for offering tips on how to frame one’s answers in a constructive manner. Commentary is also offered on highly specific topics that may be overlooked in similar texts, such as when it is imprudent to research the clinical practice issues involved with the case. The emotional impact of being sued is also addressed, with a number of coping strategies offered the author found useful.
Though understandable, the author’s antipathy for plaintiff lawyers and “hired gun” plaintiff experts is transparent and a bit off-putting. Her admonition to never discuss a case involving an unanticipated event with a hospital representative unless represented by legal counsel – while well intended – appears to impute bad faith to all individuals charged with such investigations. Moreover, there is no mention of a hospital’s duty to perform a thorough, multidisciplinary, root cause analysis (RCA) of cases that meet The Joint Commission’s definition of a sentinel event. When physicians are unwilling to candidly share their perspective during such reviews, the hospital’s ability to identify and implement patient safety improvements is significantly constrained.
Following the content highlighted above, practical strategies to reduce the likelihood of being sued are also offered. Topics include (but are not limited to): informed consent and refusal, medical record documentation, effective communication, and the risk of keeping “personal notes.” Because such practices are only touched on, readers should exercise caution when applying such advice in a specific case; to do so could be problematic. For instance, the section pertaining to patients leaving against medical advice (AMA) advises that if the patients are determined to be impaired, mentally incompetent, and unable to make a proper decision for their care “you cannot allow them to leave the hospital AMA.” It would have been useful to have explained that unless such detentions are carried out in strict conformance with applicable statutes, individuals held against their wishes could allege “false imprisonment.” Emphasizing the benefit of obtaining case-specific, concurrent legal advice would also have been helpful.
The book’s engaging style and relative brevity (136 pages) make it an easy read. The comprehensive glossary also promotes understanding of obtuse legal terms. Differences in states’ statutes in regard to: alternative dispute resolution practices, recognition of collateral payment sources, and the so-called “I’m sorry” laws are outlined in the appendices. Persons most likely to benefit from reading this book include: medical staff leaders, physicians, residents, advanced practice professionals, and those involved in claim management.
Anne Irving
Planning For Medical Adverse Effects
As much as we’d like to think that we can “get to zero” for all recurring medical errors, mistakes and adverse events will be part of medicine for the foreseeable future. In addition to working on prevention and mitigation of harm, clinicians and healthcare organizations should work on planning for the inevitable, in order to minimize harm and promote healing. Patients and families will benefit, too, if indirectly from these efforts.
Three new resources reflect the experience of clinicians and healthcare organizations following adverse events and offer practical advice and tools to minimize harm for all concerned:
Healing the Healer is a documentary film from CRICO/RMF that uses interviews and case studies to show the emotional impact of adverse events on clinicians. Click here for a preview and ordering information.?
The latest title in IHI’s Innovation Series white papers, Respectful Management of Serious Clinical Adverse Events, is available for free download. This report “introduces an overall approach and tools designed to support two processes: the proactive preparation of a plan for managing serious clinical adverse events, and the reactive emergency response of an organization that has no such plan.”?
In “Doctors Confess Their Fatal Mistakes,” Reader’s Digest presents first-person accounts of serious errors from Peter Pronovost, Eric Cropp, Bob Wachter, and others. The article reflects a sophisticated understanding of patient safety principles and is intended for a broad audience.
Three new resources reflect the experience of clinicians and healthcare organizations following adverse events and offer practical advice and tools to minimize harm for all concerned:
Healing the Healer is a documentary film from CRICO/RMF that uses interviews and case studies to show the emotional impact of adverse events on clinicians. Click here for a preview and ordering information.?
The latest title in IHI’s Innovation Series white papers, Respectful Management of Serious Clinical Adverse Events, is available for free download. This report “introduces an overall approach and tools designed to support two processes: the proactive preparation of a plan for managing serious clinical adverse events, and the reactive emergency response of an organization that has no such plan.”?
In “Doctors Confess Their Fatal Mistakes,” Reader’s Digest presents first-person accounts of serious errors from Peter Pronovost, Eric Cropp, Bob Wachter, and others. The article reflects a sophisticated understanding of patient safety principles and is intended for a broad audience.
7th Annual Connected-Health Symposium
By Mitch Work
On October 21 and 22nd, I had the opportunity to attend a symposium in Boston, organized by the Center for Connected Health, which is a division of Partners Healthcare.
On October 21 and 22nd, I had the opportunity to attend a symposium in Boston, organized by the Center for Connected Health, which is a division of Partners Healthcare.
This is a unique conference in which academics, providers, and government come together to share thoughts and ideas on new healthcare approaches, driven by new emerging technologies (robotics, genomics, and new Intranet solutions for healthcare). Also, there were many vendors showing their latest solutions that address this years’ conference theme:
The Way Forward: Reforms New Focus on Health and Wellness, Independent Aging, Chronic Condition Self-Care and the Tools That Support Them.
The organizers, Joe Kvedar, MD; Joe Ternullo, JD, MPH; and Khinlei Myint-U, MBA, should be given kudos for attracting some great speakers. The event was well attended, with over a 1,000 attendees — apparently a conference record — which is commendable in this recession era, though a large number were from the neighborhood: nearby Harvard, its med school, Partners, and Mass General. Connected Health reports 42 exhibitors, but there seemed to be more, as they could barely be housed in the mezzanine of the Park Plaza Hotel and Towers. Next year, with any growth, they may need to seek out a larger facility — a nice problem to have in these economically constrained times.
One thing that I particularly liked about the conference were the presentations that focused on the behavioral (psycho-social) influencers and just how important they are to healthcare, whether it be motivating employees to contribute to a health savings plan or figuring out how to best recruit and retain patients with chronic conditions for remote home telemonitoring programs or smoking cessation.
The first day keynoters included Kevin Davies who talked about implications of genomic sequencing tests that are now available and for $1,000; you can have 500 tests run from a sample of saliva. So now it’s not, “Can we?” (we can) but, “Should we?” and what are the implications. BJ Fogg, director of Stanford’s Persuasive Technology Lab, followed with a talk on “Designing for behavior change: Hot triggers for new habits and challenges in influencing behavior change using technologies like the Internet. This is not a hard science, and he acknowledges that changing behavior is hard individually (think smoking cessation), even though overall human behavior may be predictable. So start small, do experiments that are simple and executable. Make mistakes. Learn. Try again. Effective triggers are aimed at helping us do what we want to do. They are most effective when we put hot triggers in the path of motivated people.
More than any other conference I’ve attended, there were many book launches and signings at the conference — nine in all. Connected Health provides a useful list of authors with bios and links to Amazon.com on the symposium website.
A true “ah-hah” moment for me came during a one-to-one interview with Dr. Roy Schoenberg, MD, MPH, preident and CEO of a company started in 2006, called American Well. Using the Internet, the company provides online patient/physician consultation services in near real time with a patient going online and requesting a consultation for a particular medical problem with a physician who is on call at that time. A database identifies participating physicians who are available to consult immediately with the patient. The patient’s health problem and history are made available for review by accessing large patient databases quickly. Patient or physician can opt out of the consult at will. Fees are low. No waiting for appointments. Physicians are even insured for each consultation. I think you will be hearing more about American Well in the near future.
Day Two of the conference featured more great presentations including a keynote by Dr. Sheena Iyengar from Columbia Business School on the Art of Choosing. Many of the panelists in the breakout groups were among the best and brightest in this field. My only frustration was that some of the presentation topics that were compellingly titled in the program were never addressed by the panel. A little more rigor would be appreciated. Or is it just me?
All told, this is conference is filled with lots of new ideas and smart participants and worth considering for 2011.
American College of Radiology Third Annual Conference Covers Quality and Patient Safety
The American College of Radiology (ACR) held its third annual conference on quality and safety in radiology — Maximizing Value in Radiology Through Quality and Safety Improvements — Oct 22 and 23 in Phoenix, Arizona. The conference was organized by the ACR and drew heavily from expertise at Mayo Clinic (Rochester, Minn., and Scottsdale, Ariz.) and Virginia Mason Medical Center in Seattle. Daniel Johnson, MD, FACR, chair of radiology at Mayo Clinic Arizona, was program chair.
The program covered central principles of patient safety and quality improvement in the context of radiology and reported in depth on radiology-specific problems and solutions.
Though the format was not the most important factor in the conference’s impact, it certainly added value to the program. Presentations were either 10 or 20 minutes long, and it’s easy to imagine that having limited time encouraged speakers to be succinct and focused. To quote Toby Gilk, an MRI safety expert who attended and spoke at the conference: “All wheat; no chaf.”
The two-day program was organized into an overview plus four sessions focused on safety, utilization, process improvement, and physician outcomes. In addition, 16 proffered papers were presented in 10-minute overviews. These summaries provided enticing “tip of the iceberg” glimpses into meaningful, applicable research. Click here to see the program.
Another aspect of the program was Q&A discussions, which I enjoyed for their content as well as format. At the conclusion of each topical session, the speakers—usually three or four—took questions as a panel, which worked well for framing questions around broad issues and fostering conversation among the speakers. Questions from the audience provided another sub-plot. Many questions were along the lines of, “Thank you for your presentation. I’m in private practice (or in one case, managing a collection of small practices, ‘Onesies and twosies’) and trying to figure out how I can apply these principles to my practice with very limited resources.” I see private practices joining the patient safety conversation in increasing numbers. I hope that all organizations that sponsor conferences about safety and quality, including ACR, will begin to include strategies for smaller practices with limited budgets.
For the rest of the blog please visit- www,psqh.com
The program covered central principles of patient safety and quality improvement in the context of radiology and reported in depth on radiology-specific problems and solutions.
Though the format was not the most important factor in the conference’s impact, it certainly added value to the program. Presentations were either 10 or 20 minutes long, and it’s easy to imagine that having limited time encouraged speakers to be succinct and focused. To quote Toby Gilk, an MRI safety expert who attended and spoke at the conference: “All wheat; no chaf.”
The two-day program was organized into an overview plus four sessions focused on safety, utilization, process improvement, and physician outcomes. In addition, 16 proffered papers were presented in 10-minute overviews. These summaries provided enticing “tip of the iceberg” glimpses into meaningful, applicable research. Click here to see the program.
Another aspect of the program was Q&A discussions, which I enjoyed for their content as well as format. At the conclusion of each topical session, the speakers—usually three or four—took questions as a panel, which worked well for framing questions around broad issues and fostering conversation among the speakers. Questions from the audience provided another sub-plot. Many questions were along the lines of, “Thank you for your presentation. I’m in private practice (or in one case, managing a collection of small practices, ‘Onesies and twosies’) and trying to figure out how I can apply these principles to my practice with very limited resources.” I see private practices joining the patient safety conversation in increasing numbers. I hope that all organizations that sponsor conferences about safety and quality, including ACR, will begin to include strategies for smaller practices with limited budgets.
For the rest of the blog please visit- www,psqh.com
Thursday, November 11, 2010
CAPS Joins the Fight Against Medication Errors
Chicago, Illinois, October 15, 2010—Medication errors are one of the most widespread and preventable causes of harm in modern healthcare. Now Consumers Advancing Patient Safety (CAPS) and more than a dozen other leaders in the field are teaming up to promote best practices to prevent them.
Together with Joint Commission, the Society of Hospital Medicine and other leaders in hospital healthcare, CAPS has endorsed a new white paper that gives hospitals practical recommendations for implementing system-wide medication reconciliation programs.
The white paper, Making Inpatient Medication Reconciliation Patient Centered, Clinically Relevant, and Implementable: A Consensus Statement on Key Principles and Necessary First Steps, is available via the following link.
It will also be published in the Journal of Hospital Medicine.
“Medication reconciliation can be a complex challenge to tackle,” says Mitchell Dvorak, CAPS executive director. “The new white paper gives clinicians, quality and safety personnel, and regulatory agencies practical steps for reducing medication-related preventable harm.”
To read more please visit Patient Safety & Quality Healthcare
New Fall Alarm System For Hospitals Announced
Dedham, Massachusetts, September 20, 2010—AliMed, a major fall alarm innovator and supplier, announced the release of a revolutionary new fall alarm system for hospitals that is budget friendly, reduces stocking multiple products to save costs, and is simpler to use. It employs new technologies not found in other fall alarm systems. It’s a system that delivers more at less cost because of technology advances.
The IQ Easy alarm controller switches on and operates automatically with no setup required. The IQ Easy connects to an ultra thin sensor pad which, unlike other sensor pads, functions on proximity and not pressure. It can be used on any size patient from pediatric to bariatric, and on any chair or bed surface including air mattresses.
Jon Bretz, AliMed’s VP of Sales and Marketing said, “Hospitals asked us for a very simple and inexpensive system that had a single-patient use lifespan and cost. The sensor pad is ultra thin and made from Tyvek with the proximity technology embedded in the surface of the pad. It is inexpensive compared to conventional sensor pads, and is replaced after each use to reduce cross contamination. The alarm controller and the cable from the controller to the sensor can be sanitized and reused.”
For more information on Fall Alarms For Hospitals please visit http://www.psqh.com/product-news/657-major-innovation-in-fall-alarms-marries-simplest-to-use-alarm-with-ultrathin-sensor-pad-for-hospitals-at-a-lower-cost.html
The IQ Easy alarm controller switches on and operates automatically with no setup required. The IQ Easy connects to an ultra thin sensor pad which, unlike other sensor pads, functions on proximity and not pressure. It can be used on any size patient from pediatric to bariatric, and on any chair or bed surface including air mattresses.
Jon Bretz, AliMed’s VP of Sales and Marketing said, “Hospitals asked us for a very simple and inexpensive system that had a single-patient use lifespan and cost. The sensor pad is ultra thin and made from Tyvek with the proximity technology embedded in the surface of the pad. It is inexpensive compared to conventional sensor pads, and is replaced after each use to reduce cross contamination. The alarm controller and the cable from the controller to the sensor can be sanitized and reused.”
For more information on Fall Alarms For Hospitals please visit http://www.psqh.com/product-news/657-major-innovation-in-fall-alarms-marries-simplest-to-use-alarm-with-ultrathin-sensor-pad-for-hospitals-at-a-lower-cost.html
RFID – An Alternative to Barcodes at the Bedside?
Barcoding has become established in several industries as an inexpensive and reliable automatic identification technology that can overcome human error in capturing and validating information. In the decades since its creation, barcoding has become highly standardized, resulting in lower costs and greater accessibility. Indeed, word processors now can produce barcodes, and many inexpensive printers print barcodes on labels. Most current barcode scanners autodiscriminate between 12 and 15 symbologies and all their variants without requiring configuration or programming and, when programming is required, these same barcodes scanners can be programmed for specific uses by simply scanning the appropriate barcodes within the scanner’s user manual.
Despite these significant developments, the adoption of barcoding has been slower in the healthcare sector than the retail and manufacturing sectors. Barcoding can capture and prevent errors during medication administration and is now finding its way from the bedside into support operations within the hospital. A study from Brigham and Women’s Hospital in Boston showed that the number of near misses detected by barcode scanning at the bed side could be cut in half by implementing barcode verification of medications at dispensing or compounding (Cooley, 2008).
For rest of article please visit Patient Safety & Quality Healthcare .
Thursday, November 4, 2010
Hospitals Collaborate to Prevent Wrong-Site Surgery
The wrong-site surgery prevention program is one of numerous patient safety initiatives undertaken collaboratively by hospitals in the Greater Philadelphia region since 2006 under the direction of the Partnership for Patient Care (PPC). Primarily funded by Independence Blue Cross and the hospital community, PPC’s goal is to accelerate the adoption of evidence-based clinical practices by pooling the resources, knowledge, and efforts of healthcare providers and other stakeholders. The PPC is led by HealthCare Improvement Foundation (HCIF), an independent non-profit organization promoting innovative efforts to improve health services and the enhancement of public trust and confidence in the region’s health care systems. HCIF partnered with ECRI Institute, a non-profit organization researching best practices to improve patient care, to facilitate the collaborative’s shared approach.
The partnership has made a meaningful difference in improving patient safety in the Greater Philadelphia area. Building on the success of previous PPC initiatives where improvement was demonstrated through a collaborative effort, the wrong-site surgery prevention initiative adopted an approach in which participating organizations share common goals, apply interventions shown to improve performance, and share experiences with one another.
To view the full article please visit www.psqh.com
Delaware Tightens Oversight of Physicians
By
In July, Delaware Governor Markell signed a set of nine bills that tighten oversight of physicians and increase protection of children in medical care. Known collectively as The Bradley Bills, Delaware’s new legislation is the most comprehensive of its kind in the country and is named after a physician pedophile who got away with sexual abuse or rape of more than 100 children over the course of 10 years, while fellow physicians, hospitals, government agencies, and others looked the other way. Complaints from parents and nurses were ignored. The story has vast implications for peer review, physician autonomy, medical staff governance, the role of hospitals in medical staff oversight, the limitations of “small government,” the role of the press in exposing system failures, the need for transparency, and a host of other hot topics. I’ll let you draw your own conclusions, so here is the story:
Pediatrician Earl Bradley came to Delaware in 1994, and over the course of the next 10 years was investigated five times for allegations of sexual abuse of children. Each of those investigations went nowhere and each of the agencies did not inform one another, let alone the public, of the allegations or the investigations. Indeed, it was only after The News Journalsubpoenaed documents and revealed the extent of the allegations and mishandling of the investigations that Delaware’s Attorney General, Beau Biden, initiated an investigation that ultimately led to the new laws.
To read the complete article please visit- http://www.psqh.com/online-articles/580-delaware-tightens-oversight-of-physicians.html
In July, Delaware Governor Markell signed a set of nine bills that tighten oversight of physicians and increase protection of children in medical care. Known collectively as The Bradley Bills, Delaware’s new legislation is the most comprehensive of its kind in the country and is named after a physician pedophile who got away with sexual abuse or rape of more than 100 children over the course of 10 years, while fellow physicians, hospitals, government agencies, and others looked the other way. Complaints from parents and nurses were ignored. The story has vast implications for peer review, physician autonomy, medical staff governance, the role of hospitals in medical staff oversight, the limitations of “small government,” the role of the press in exposing system failures, the need for transparency, and a host of other hot topics. I’ll let you draw your own conclusions, so here is the story:
Pediatrician Earl Bradley came to Delaware in 1994, and over the course of the next 10 years was investigated five times for allegations of sexual abuse of children. Each of those investigations went nowhere and each of the agencies did not inform one another, let alone the public, of the allegations or the investigations. Indeed, it was only after The News Journalsubpoenaed documents and revealed the extent of the allegations and mishandling of the investigations that Delaware’s Attorney General, Beau Biden, initiated an investigation that ultimately led to the new laws.
To read the complete article please visit- http://www.psqh.com/online-articles/580-delaware-tightens-oversight-of-physicians.html
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