Wednesday, August 31, 2011

ConversePoint Developing New Communications Platform for Hospitals

ConversePoint, has announced its plans to develop and commercialize a communications platform for the healthcare industry that will significantly save clinicians time, hospitals millions in productivity costs and improve accountability measurements for critical events per the Joint Commission's National Patient Safety Goals along with the license of key Qualcomm technology.

The ConversePoint platform will integrate asynchronous communication technology developed by Qualcomm Incorporated, the world leader in 3G and next-generation mobile technologies, with proprietary ConversePoint technologies to create a new solution that will work seamlessly with multiple mobile communication standards, mobile carriers, or mobile devices.

"ConversePoint will greatly improve how hospitals function," said Shawn Evans, Chief of Staff and Attending Emergency Physician for Scripps Memorial La Jolla Hospital based in San Diego, CA. "Until now, there has been no solution that truly understands the needs of clinicians and effectively solves them. It allows us much greater efficiencies, which translates into better patient care."

Don Jones, VP of Wireless Health Global Strategy and Market Development for Qualcomm Labs and a member of ConversePoint's advisory team, states, "Qualcomm selected ConversePoint because of the team's extensive expertise in building complex, high-value, telecom-grade mobile and software technologies that fuel game-changing businesses. ConversePoint will change the notoriously hectic nature of communications in today's healthcare environment."

The founders of ConversePoint, Marisa Bryce, CEO, and Randall Menna, CTO, have a long collaboration with Qualcomm, having developed core transactional and communication solutions for Qualcomm over the past 10 years that have been used, purchased and adopted by millions of users over multiple carriers and industries, including healthcare, transportation, consumer products and financial services.


ACR Responds to The Joint Commission Sentinel Event Alert

The Joint Commission (TJC) issued a Sentinel Event Alert titled “Radiation Risks of Diagnostic Imaging.” Such alerts are issued periodically by TJC to describe underlying causes of these sentinel events and to suggest steps to prevent occurrences in the future.
This alert indicates general agreement that “care should be taken to weigh the medical necessity of a given level of radiation exposure against the risks, and that steps should be taken to eliminate avoidable exposure to radiation.” This message concurs with the message that the ACR has been sending to its members, patients and the general public for several years.

However, the alert indicates that the CMS January 2012 requirement for accreditation of CT, MRI, and PET was promulgated “as a result of the potential dangers associated with ionizing radiation.” The ACR, a sponsor of the legislation requiring this accreditation, considers this statement inaccurate, first because the legislation is aimed primarily at ensuring a high level of quality for these modalities, including inspection and evaluation of image quality and, second because MRI, a component of the accreditation requirement, produces no ionizing radiation.

A second inaccuracy is the statement that the ACR launched its National Radiology Data Registry (NRDR) in May. In fact, NRDR has been in existence since 2008. In May 2011, the ACR launched its Dose Index Registry (DIR), a national registry that permits facilities to monitor dose from each CT scanner and compare those doses to national benchmarks. The TJC Alert unfortunately makes no specific mention of the existence of the DIR.
We are pleased TJC acknowledges that “experts disagree on the extent of the risks of cancer from diagnostic imaging” but we are concerned with the recommendation for “awareness of the potential dangers from diagnostic radiation among organizational leadership, hospital staff and patients” considering that there is significant scientific disagreement on the magnitude of those dangers.

In general, the ACR applauds TJC’s alert for its comprehensiveness and strong recommendations regarding selection of the right procedure and the right dose, creating effective processes, ensuring safe technology and promoting a safety culture. The College is particularly pleased to have already addressed, through its DIR, recommendation 19 which endorses the creation of a national registry to track radiation doses.

To read more about patient safetyhe Joint Commission (TJC) issued a Sentinel Event Alert titled “Radiation Risks of Diagnostic Imaging.” Such alerts are issued periodically by TJC to describe underlying causes of these sentinel events and to suggest steps to prevent occurrences in the future.
This alert indicates general agreement that “care should be taken to weigh the medical necessity of a given level of radiation exposure against the risks, and that steps should be taken to eliminate avoidable exposure to radiation.” This message concurs with the message that the ACR has been sending to its members, patients and the general public for several years.

However, the alert indicates that the CMS January 2012 requirement for accreditation of CT, MRI, and PET was promulgated “as a result of the potential dangers associated with ionizing radiation.” The ACR, a sponsor of the legislation requiring this accreditation, considers this statement inaccurate, first because the legislation is aimed primarily at ensuring a high level of quality for these modalities, including inspection and evaluation of image quality and, second because MRI, a component of the accreditation requirement, produces no ionizing radiation.

A second inaccuracy is the statement that the ACR launched its National Radiology Data Registry (NRDR) in May. In fact, NRDR has been in existence since 2008. In May 2011, the ACR launched its Dose Index Registry (DIR), a national registry that permits facilities to monitor dose from each CT scanner and compare those doses to national benchmarks. The TJC Alert unfortunately makes no specific mention of the existence of the DIR.
We are pleased TJC acknowledges that “experts disagree on the extent of the risks of cancer from diagnostic imaging” but we are concerned with the recommendation for “awareness of the potential dangers from diagnostic radiation among organizational leadership, hospital staff and patients” considering that there is significant scientific disagreement on the magnitude of those dangers.

In general, the ACR applauds TJC’s alert for its comprehensiveness and strong recommendations regarding selection of the right procedure and the right dose, creating effective processes, ensuring safe technology and promoting a safety culture. The College is particularly pleased to have already addressed, through its DIR, recommendation 19 which endorses the creation of a national registry to track radiation doses.

Please visit Patient Safety & Quality Healthcare

AED Failures Connected to Deaths From Cardiac Arrest

More than one thousand cardiac arrest deaths over 15 years are connectedautomated external defibrillators (AEDs) failure; battery failure accounted for almost one-quarter of the failures. The study was published in Annals of Emergency Medicine (“Analysis of Automated External Defibrillator Device Failures Reported to the Food and Drug Administration” http://bit.ly/ox6YYr).


“Survival from cardiac arrest depends on the reliable operation of AEDs,” said lead study author Lawrence DeLuca, MD, of the University of Arizona Department of Emergency Medicine in Tucson. “AEDs can truly be lifesavers but only if they are in good working order and people are willing to use them.”

Researchers analyzed reports to the Food and Drug Administration (FDA) about all adverse events connected to use of an AED between January 1993 and October 2008. Of the 40,787 AED-related events reported to the FDA, 1,150 adverse events connected to fatalities were reported. Almost half (45 percent) of failures occurred during the attempt to charge and deliver a recommended shock to the person in cardiac arrest. Problems with pads and connectors accounted for 23.7 percent of the failures, and battery power problems accounted for 23.2 percent of the failures.

Sudden cardiac arrest is a leading cause of death in North America and Europe. Odds of survival decline by 7 to 10 percent per minute of delay in defibrillation. Even as AEDs have proliferated in public places such as airports and offices, bystanders are reluctant to use them. An Annals of Emergency Medicine study published earlier this year found that less than half of people in public places reported being willing to use an AED and more than half were unable to recognize one.

for more information on adverse medical events and patient safety please visit Patient Safety & Quality Healthcare

Tuesday, August 30, 2011

Ardent Health Services Expand Use of Surgical Information Systems to Include Patient Tracking


 Ardent Health Services of Nashville, Tenn. will expand its system-wide use of the Surgical Information Systems Solution to include anesthesia automation, analytics and patient tracking on a single perioperative record.  In preparation for upcoming meaningful-use criteria, Ardent will partner with SIS to be interoperable with McKesson systems in its hospitals in Albuquerque, N.M. and Tulsa, Okla. in order to improve patient safety, ease of use and functionality.

"The SIS Solution will allow us to improve our care to patients," said Steve Landgarten, M.D., chief medical officer and chief quality officer of Ardent Health Services.  "With these modules, caregivers in our hospitals can view important patient information in real-time such as which medications have been administered, when they were administered and what impact those medications have over time.  It's a much improved patient tracking, documentation and analytics process."

SIS Anesthesia is the only specialty anesthesia system featuring a shared database with a perioperative system.  This shared database enables continuity of care as any change to the perioperative record that impacts the anesthesia record is automatically reflected in the anesthesia record, optimizing the automation of the care process.  A single perioperative record is efficient, easy-to-use, cost effective and provides for consistent documentation across the perioperative continuum – supporting a higher quality of patient care.

For more information on patient safety and pharmacy automation please visit Patient Safety & Quality Healthcare

Monday, August 29, 2011

The Joint Commission Issues Sentinel Alert on Radiation Risks

The Joint Commission (TJC) issued a Sentinel Event Alert titled “Radiation Risks of Diagnostic Imaging.” Such alerts are issued periodically by TJC to describe underlying causes of these sentinel events and to suggest steps to prevent occurrences in the future. This alert indicates general agreement that “care should be taken to weigh the medical necessity of a given level of radiation exposure against the risks, and that steps should be taken to eliminate avoidable exposure to radiation.” This message concurs with the message that the ACR has been sending to its members, patients and the general public for several years.

However, the alert indicates that the CMS January 2012 requirement for accreditation of CT, MRI, and PET was promulgated “as a result of the potential dangers associated with ionizing radiation.” The ACR, a sponsor of the legislation requiring this accreditation, considers this statement inaccurate, first because the legislation is aimed primarily at ensuring a high level of quality for these modalities, including inspection and evaluation of image quality and, second because MRI, a component of the accreditation requirement, produces no ionizing radiation.

To read the full article please visit Patient Safety & Quality Healthcare

Philips Releases Remote Patient Monitor

Royal Philips Electronics announced the global release of IntelliVue MX40, a wearable patient monitor that can be used for the monitoring of ambulatory patients and during patient transport. The MX40 combines the benefits of the IntelliVue X2 and Philips telemetry into a single, compact wearable monitor. MX40 helps clinicians to better manage patient alerts and is designed with infection control in mind.

Many patients can benefit from mobile monitoring in the hospital, including those who can be monitored in a progressive care area or during supervised recovery from an acute event or surgical procedure. Mobile monitors also help clinicians spend more time with patients: one hospital estimates that its nursing staff saves an average of 40 minutes every day by using the MX40 display to check patients’ ECG rhythms, instead of calling a technician at the central station monitor.MX40 can help clinicians to better and more systematically manage patient alerts both at the patient and at the hospital’s central monitoring station.

"The MX40 is helpful in streamlining patient monitoring at the bedside. The mobile monitoring function helps us ensure patient safety during transfers and while infusing medication drips,” Alycia Kielty, RN, Surgical Cardiovascular unit, Sanford USD Medical Center in Sioux Falls, South Dakota said. “For us, these added product benefits have increased communication efficiency, and decreased the need for extra bulky equipment."

For more information on Patient Safety and Patient Monitoring please visit Patient Safety & Quality Healthcare

Thursday, August 25, 2011

Joint Commission Warns About Diagnostic Radiation Dangers

A new Joint Commission Sentinel Event Alert warns that health care organizations must seek new ways to reduce exposure to repeated doses of harmful radiation from diagnostic procedures. The Alert urges greater attention to the risk of long-term damage and cumulative harm that can occur if a patient is given repeated doses of diagnostic radiation.


Over the past two decades, the U.S. population’s total exposure to ionizing radiation has nearly doubled with the increased use of diagnostic imaging in hospitals, imaging centers, physician and dental offices. Any physician can order radiologic tests at any frequency with no knowledge of when the patient was last irradiated or how much radiation the patient received. Several recent studies have raised concerns about the risk of cancer from diagnostic imaging, especially in vulnerable populations such as children, young adults and pregnant women.

“Diagnostic imaging is a necessary medical tool, but it must be used with great care,” says Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., president, The Joint Commission. “Although there is still debate about how much is too much radiation, and the timeframe within which radiation can be safely administered, the recommendations in this Alert give health care organizations practical strategies to make sure that patients get the right diagnostic imaging tests with the lowest dose of radiation needed to make a diagnosis. In addition, The Joint Commission’s standards support the use of safe and effective diagnostic radiation and promote a safety culture, which is necessary for the safe use of diagnostic radiation.”

To read full article please visit Patient Safety & Quality Healthcare

Baxter International To Acquire Baxa

Baxter International Inc. has entered into a definitive agreement to acquire Baxa Corporation. Baxa develops pharmacy technology that enhances the efficiency and patient safety of oral and IV dose preparation and delivery.  The addition of Baxa's product lines will complement Baxter's portfolio of nutrition products and drug delivery systems and supports patient safety.

"With these new offerings, Baxter will be able to provide a comprehensive solution to fulfill the majority of patients' nutritional requirements and increase efficiency in the pharmacy," said Robert M. Davis, president of Baxter's Medical Products business. "Bringing this expertise together with Baxter's commercial capabilities and global reach will enable us to continue to meet our customers' evolving needs and extend our position in IV nutrition and fluid delivery."


The transaction includes a total upfront cash consideration of $380 million and is expected to close following satisfaction of customary closing conditions and the expiration or early termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act. 

Annual sales for Baxa were approximately $150 million in 2010, and Baxter expects the future top-line growth of this business to be accretive to the company's future sales growth.  In addition, Baxter expects this transaction to be neutral to full-year 2012 earnings excluding dilution of approximately $0.03 to $0.05 per diluted share related to acquisition accounting and transaction-related expenses, and increasingly accretive thereafter.

For more information about medication safety and patient safety please visit www.psqh.com

Wednesday, August 24, 2011

Boston Medical Center Announces New VP for Quality and Patient Safety

Boston Medical Center announced that Dr. Stanley Hochberg will become vice president for quality and patient safety starting October 1st. Hochberg will replace Dr. William Barron, who left in May to become chief medical officer at the University of California Irvine Medical Center.

As Vice President for Quality and Patient Safety/Chief Quality Officer, Hochberg will lead BMC’s health care quality and safety programs, with the charge of continuing to improve the effectiveness, efficiency, safety and timeliness of inpatient and outpatient care. He will oversee and manage the hospital’s quality improvement, performance improvement, risk management, quality measurement and infection control functions. In this role, he will continue to build upon successful efforts to foster a culture of quality, transparency and patient safety at BMC.

To read more about Patient Safety and Quality Improvement and the latest industry6 news please visit www.psqh.com

Tuesday, August 23, 2011

NYT Reports On Patient Safety Progress

A Better Way to Keep Patients Safe
By PAULINE W. CHEN, M.D.


Not long ago, a few colleagues and I were discussing the challenges of improving health care quality and patient safety. We debated the merits of clinical benchmarks that payers and regulatory groups now require, crude proxies of quality care like giving antibiotics at certain times, ordering specific tests at set intervals or permitting our results to be reported publicly.
One colleague, a devoted and highly respected clinician in his department, admitted that he found this growing list of directives from others exasperating. “I’m all for taking great care of patients,” he said, the muscles along his jaw tightening. “But how can some insurance bureaucrat or policy wonk who’s not in the clinical trenches know more about taking good care of real patients than someone like me?”

Since 1999, when a national panel of experts released landmark report on the high number of medical errors, insurers, policy makers and regulatory groups have been piling onto the quality-improvement wagon with ever increasing gusto. As a result of their enthusiastic efforts, hospital accreditation procedures and standards have become more rigorous, physician duty hours have been trimmed, hand-sanitizing gel dispensers in hospitals have multiplied and physician reimbursement has been linked increasingly with quality goals and less with the number of CT scans ordered.

But few of these quality enthusiasts are actually caring for patients. And when a study in The New England Journal of Medicine last fall reported that despite all the efforts and new financial incentives, there was no significant decrease in patient injuries, these same enthusiasts were quick to point to the inertia and intractable attitudes of the medical “culture.” They noted that less than 2 percent of hospitals had installed comprehensive electronic medical records systems, doctors and nurses were routinely working in excess of limits on duty hours and few were paying attention to even simple hand-washing recommendations. It would take nothing short of an all-out legislative, financial and regulatory assault to change the system, many of them concluded.

To read the full article please visit NYT

Patient Safety & Quality Healthcare is one of the few publications devoted exclusively to patient safety and healthcare quality outcomes. Through a website, print publication and email newsletter- PSQH eNews Alert we provide updated information and real world success stories of hospital programs that have reduced medical errors and saved lives.

Patient Safety First Reports Helping Save 800 Lives

Patient Safety First reports that it has helped save eight hundred lives by preventing sepsis-related deaths. Patient Safety First is a three-year collaboration between the National Health Foundation, California's Regional Hospital Associations, and Anthem Blue Cross to improve the consistency and quality of health care for Californians.


"Patient Safety First is one of the most challenging and potentially rewarding endeavors ever undertaken in the health care system," said Dr. Eugene Grigsby, president of the National Health Foundation, which verified the initial outcomes of the initiative.  "It strives to engage California hospitals in learning collaborations with the specific goal of improving patient safety and cost savings for those needing hospitalization."

The initiative, which brings together more than 160 participating hospitals from across the state, has led to a:
  • 41 % reduction in ventilator associated pneumonia (VAP);
  • 25 % reduction in central line blood stream infections (CLBSI);
  • 24 % reduction in catheter associated urinary tract infections (CAUTI); and
  • a reduction in birth traumas and elective deliveries prior to 39 weeks gestation.

Early data suggest the Patient Safety First initiative in California has already resulted in a cost-avoidance of over $11 million. This is money that would have been used to care for patients who would have developed sepsis and other hospital acquired infections if they had not been able to avoid illness as a result of the shared learning made possible by the collaboration.

"First year results show that this type of collaboration works," Grigsby said. "Lives are being saved, incidents of hospital-acquired infections are being reduced and savings are being achieved. Knowledge gained from the first year of the program will be applied in the second and third year of the initiative to help reach the goal of 'zero' hospital acquired infections by the end of year three. Reaching this goal will greatly impact Californians and participating hospitals."

The nation's largest state based patient-safety collaborative, Patient Safety First leverages regional peer-to-peer learning networks to accelerate the adoption of established best practices and quality improvement programs such as Sepsis Early Goal Directed Therapy (EGDT); and the new March of Dimes Toolkit established to eliminate non-medically indicated deliveries before 39 weeks gestational age.

Advanceweb Highlights Role of Infection Preventionist

From Advanceweb.com
By Donna Williams

Today's battle with HAIs has become more difficult to fight. MRSA,VRSA, VISA are ganging up on us. We need reinforcements. A new title in infection control has emerged in response to the increase in HAIs. This role has taken the infection control department to a higher level.
The infection preventionist (IP) is an expert in educating the patient and hospital staff on patient safety measures related to reducing hospital acquired infections.

The infection preventionist will develop and implement practices for safety by using surveillance techniques along with other activities to help improve patient care in the fight against HAIs. As with any team approach, the IP will follow up with the healthcare team and the patients to effectively monitor compliance.

The Association for Professional Infection Control and Epidemiology (APIC) has a new campaign titled, "Infection Prevention and You." The idea is to incorporate a team approach using evidence-based practice for healthcare workers and patients in the fight against hospital acquired infections. Patients may receive educational materials to familiarize themselves about what they can do to prevent infections. The information contains tips on helping the patient to effectively communicate with their healthcare team.

To read full blog post please visit AdvanceWeb

New Treatment Model Targets Improved Patient Outcomes at Free Clinic

The Jeanie Schmidt Free Clinic (JSFC) has received a CareFirst BlueCross BlueShield (CareFirst) grant to expand its Shared Medical Appointment program, a treatment model designed to increase clinic capacity, maximize staff and volunteer efficiency, and empower patients to engage in their own health care outcomes. The $50,000 CareFirst grant will allow the clinic to serve as many as 150 chronically ill patients in Fairfax County, an expansion of the Clinic’s original pilot group of 15 patients. LISTEN TO AUDIO FROM THE EVENT.

Shared medical appointments deliver routine and follow-up care in small group settings, in this case for the chronically ill. The visits are voluntary and provide secure and interactive environments for patients to have access to physicians, nurse practitioners and specially trained chronic disease and wellness educators that can provide treatment and counseling as a health care team. Patients benefit from the ability to interact and support other patients experiencing similar health issues. Educators offer counseling on diabetes, blood pressure, nutrition, and other healthy behaviors to improve the overall wellness of program
participants. 

To read full news release please visit Patient Safety & Quality Healthcare

Johns Hopkins Research-Healthcare Quality Programs Save Lives and Millions of Dollars

A new Johns Hopkins research suggests that a healthcare quality improvement program that saves lives by dramatically reducing potentially lethal bloodstream infections in hospital intensive-care units across the state of Michigan also saves those hospitals an average of $1.1 million a year.

As policymakers frantically search for ways to cut health care costs, the findings also give weight to those who have long suggested that reducing preventable harm isn’t just good for patient safety, but also the bottom line, the researchers say. In the Michigan program, there was a tenfold return on investment, they say.

“We already knew that the Michigan project saved lives and reduced infections,” said Peter J. Pronovost, M.D., Ph.D., director of Johns Hopkins’ Armstrong Institute for Patient Safety and Quality and leader of the study described in the September/October issue of the American Journal of Medical Quality. “Now we know that by preventing infections, hospitals actually save money too.”

The new study showed that each central line-associated bloodstream infection in Michigan costs a hospital an average of $36,500 to treat. Implementing the patient safety program cost roughly $3,375 per infection averted between 2003 and 2005. The cost of putting the program in place, mostly in devoted staff time, was an average of $161,000 per hospital.

To read the full press release please visit Newswire

Friday, August 19, 2011

Parkland Memorial Hospital To Release Report on Patient Safety at the Dallas Hospital

Published in the Dallas Morning News
By Sherry Jacobson and Miles Moffeit



A  highly critical federal government report on patient safety at Parkland Memorial Hospital will be released Friday at a special meeting of the hospital’s board of managers.“We promised we would release it as soon as it was finished, and that’s what we’re doing,” said Parkland spokeswoman April Foran.

Two dozen teams of doctors, nurses, lawyers and other hospital employees have spent the last two weeks developing a plan to correct problems that federal health care inspectors said threatened patient safety at the Dallas County public hospital, she said.

Investigators with the U.S. Centers for Medicare & Medicaid Services, or CMS, found that Parkland put emergency room patients’ lives at risk and failed to take sanitary measures, such as hand-washing, to prevent the spread of infection, according to an internal hospital memo circulated last week.


Those were the most severe failures of nine regulatory violations found by CMS during a sweeping inspection of the hospital in July. Parkland has until Saturday to submit to CMS a plan of corrective measures or face losing hundreds of millions of dollars in federal funding.
The federal agency put Parkland on “immediate jeopardy’’ status, the most severe designation regulators can give medical facilities. That means the government is concerned that a “crisis” exists and that funding should be terminated if the situation isn’t corrected.
The CMS inspection was triggered by the Feb. 10 death of George Cornell, a patient in Parkland’s psychiatric emergency department. He died in solitary confinement after being pinned face-down by two staff technicians. Parkland failed to report the death to federal and state regulators, as required, and officials began investigating only after The Dallas Morning News publicly revealed it.

To read the full article please visit www.dallasnews.com .

To read about case studies of successful patient safety programs in hospitals  please visit Patient Safety & Quality Healthcare

Stamford Hospital Announces New Promotions for Chief Medical Officer and Enterprise Risk Management

Stamford Hospital announced the promotion of Dr. Sharon Kiely  to the role of Senior VP, Medical Affairs & Chief Medical Officer and Ruth Cardiello, R.N., M.S.N., has been promoted to VP, Enterprise Risk Management. Dr. Kiely previously served as V.P., Quality & Chief Quality Officer. Prior to joining Stamford Hospital, she was the V.P., Quality & Chief Quality Officer, Vice Chair Department of Medicine, Director of Hospitalist Services & Medical Director, Quality & Patient Safety at Allegheny General Hospital , an affiliate of the West Penn Allegheny Health System in Pittsburgh, Penn.

Dr. Kiely received her medical degree from Georgetown University School of Medicine and completed her residency in Internal Medicine, Primary Care Track, at St. Vincent’s Hospital and Medical Center in New York. She received a master’s degree in Public Management from the H. John Heinz III School of Public Policy & Management at Carnegie Mellon University.

A practicing physician for over 22 years, Dr. Kiely was selected as White House Fellow in the U.S. Department of Health & Human Services.

Cardiello has worked at Stamford Hospital for 11 years, having served as Manager, Clinical Compliance; Director, Case Management & Social Work; Director, Risk Management; and in her most recent position as Executive Director, Enterprise Risk Management.

In her new position, Cardiello will provide Dr. Kiely with leadership support for Stamford Hospital’s risk management and regulatory functions.

Thursday, August 18, 2011

Accumentra Health Renews ContractWith CMS

Acumentra Health has renewed its contract with the Centers for Medicare & Medicaid Services (CMS) to serve as Oregon’s Medicare Quality Improvement Organization (QIO). Acumentra Health will work with Oregon healthcare providers to promote patient-centered care, make care safer and more affordable, and improve population health.


Healthcare quality improvement activities conducted by state-based QIOs are a key component of the National Quality Strategy to improve the quality and patient safety while lowering costs. In more than 20 years as Oregon’s QIO, Acumentra Health has worked as a convener and change agent with hospitals, nursing facilities, and physician practices throughout the state to develop and apply proven strategies for delivering safer, more efficient care.

“Our work with Oregon partners has succeeded in improving care for Medicare beneficiaries, and by extension for all Oregonians,” said Stacy Moritz, director of Medicare Quality Services for Acumentra Health. “We are proud of the real, measurable improvements made by the providers that have taken part in our Medicare initiatives.”

To read full article please visit  http://www.thelundreport.org/resource/acumentra_health_selected_to_improve_healthcare_quality_for_oregon_medicare

Barrons.com Reviews Carefusion Success and Potential for Continued Growth

By Johanna Bennett- Barrons.com

At a time when the medical-device industry has been plagued by a bad economy and slumping hospital spending, CareFusion is delivering compelling earnings growth.
To be sure, the company, which mainly makes equipment found in hospital intensive-care units, is still finding its way after spinning off from Cardinal Health (ticker: CAH) in 2009. Profit margins lag the industry average. Revenue growth remains tepid.

But CareFusion (CFN) is fixing all that. The company is making acquisitions and developing new products. And while it waits for those investments to eventually stimulate sales, it's restructuring to lower costs and boost profitability, which is fueling double-digit profit growth.
Investors are beginning to embrace the stock. At less than $26, the share price has climbed more than 14% since Aug. 8 when quarterly profit topped expectations.Still, at roughly seven times Ebitda (earnings before interest, taxes, depreciation and amortization), CareFusion is one of the cheapest medical-device names in the Standard & Poor's 500 index.

"When you look at our fundamentals, we are strong, we are well positioned and we are very, very valuable," CareFusion Chairman and Chief Executive Kieran Gallahue told Barrons.com during a recent interview.

But a focus on enhancing patient safety sets CareFusion apart from other hospital-equipment companies. That and rising infusion-pump sales following last year's mammoth recall by rival Baxter International's (BAX) led Barrons.com to write bullishly about the stock in June 2010 (see Weekday Trader, "A Stock Play on Safer Hospitals," June 22, 2010).

To read the full article please visit Barrons.com

To read more about CareFusion please visit Patient Safety & Quality Healthcare



Pittsburgh Hospitals Form Clinical Connect to Improve Patient Safety

A collaboration among nine major Pittsburgh health providers has led to the formation of ClinicalConnect, a health information exchange that will give medical personnel at participating hospitals access to critical patient information such as past hospitalizations, lab results and allergies.Participants say the system will improve patient care and patient safety while preventing unnecessary testing and other costly procedures.

Two years in the making, ClinicalConnect is a collaboration among the University of Pittsburgh Medical Center, Heritage Valley Health System, St. Clair Hospital, Jefferson Regional Medical Center, Washington Hospital, Excela Health, Butler Health System, Altoona Regional Health System and Armstrong County Memorial Hospital.

Wednesday, August 17, 2011

NextGen Healthcare Launches Enterprise Patient Portal with MEDSEEK

NextGen Healthcare Information Systems, Inc., a wholly owned subsidiary of Quality Systems, Inc.   announced it has entered into an agreement with MEDSEEK to create the NextGen® Enterprise Patient Portal. Under the agreement, NextGen Healthcare will distribute MEDSEEK's enterprise eHealth solutions to ambulatory and inpatient organizations to aid in improving patient-provider communications across health systems.

Building on the success of the existing NextGen® Patient Portal, which has enabled thousands of providers to improve clinical workflow and efficiency through electronic patient communication, MEDSEEK's eHealth ecoSystem will be introduced to strengthen the NextGen® portfolio for integrated delivery network clients. The new NextGen Enterprise Patient Portal, powered by MEDSEEK, will provide patients with ways to manage their own healthcare. 

Through a single online portal, patients can access clinical and non-clinical staff within an entire health system, as well as view test results, schedule appointments and request prescription renewals. Healthcare enterprises using NextGen® products and services will advance current workflows and address Accountable Care Organization needs with the ability to consolidate patient information from disparate electronic health record and hospital systems into a single, intuitive view.

To read the full article please visit Patient Safety & Quality Healthcare

American College of Surgeons Announces Goal to Enlist Hospitals in ACS NSQIP

The American College of Surgeons (ACS)  announced its goal to enlist at least one thousand hospitals into the National Surgical Quality Improvement Program (ACS NSQIP®). The commitment is part of the ACS Inspiring Quality initiative , an effort to raise awareness of proven models of quality improvement, coordinated care and disease management that can help improve the quality and value of health care.

The announcement was made in conjunction with the Chicago Surgical Health Care Quality Forum, an event aimed at raising awareness of quality issues and discussing quality improvement programs needed in our nation’s hospitals to reduce preventable hospital readmissions, prevent medical errors, improve patient outcomes and reduce costs. Nearly 50 Chicago health care leaders attended the event which was held at ACS’s downtown headquarters.



To read full article please visit Patient Safety & Quality Healthcare

University of Chicago Medical Center to Implement Omnicell Solution

New Solution Will Increase Medication Safety

Omnicell announced that the University of Chicago Medical Center will implement a decentralized drug dispensing model using Omnicell solutions. The 532-bed UCMC is rapidly growing to better serve patients, and will open its newest hospital pavilion in 2013. The expansion will feature the introduction of the new Omnicell G4 platform into nursing units throughout the Medical Center.

The installation will include Omnicell Inventory Management Carousels with WorkflowRx™ software for comprehensive medication inventory management, as well as Omnicell automated dispensing systems to help streamline pharmacy and nursing workflow efficiency.

Omnicell solutions are designed to integrate with the Center's computerized physician order entry (CPOE), allowing decentralized pharmacists to facilitate more efficient medication administration. UCMC chose the decentralized pharmacy practice model after an extensive review of the workflows and total cost of ownership of their previous central fill, robot system for medication administration. UCMC estimates that implementing a decentralized pharmacy practice model will result in reallocating 22,000 annual nursing hours back to patient care and away from time spent trying to locate and account for medications.

"Omnicell has designed their products to maximize medication safety and workflow efficiency," said Dave Hicks RPh, MBA, vice president and chief pharmacy officer at the University of Chicago Medical Center. "We reviewed the feature and functionality benefits of the leading competitive solutions, and we believe the new Omnicell G4 platform is a very appealing technology."


For more articles on medication safety please visit Patient Safety & Quality Healthcare

Tuesday, August 16, 2011

Canton-Potsdam Hospital Announces New VP of Quality and Performance Improvement

Susan M. Hodgson is joining Canton-Potsdam Hospital in New York State as a Vice President of Quality and Performance Improvement. Hodgson recently served as Corporate Vice President of Quality, Patient Safety with the Greater Hudson Valley Health System. She has also been Director of Quality Support Services, at The Saratoga Hospital, and Quality Management and Patient Safety Specialist at Saint Peter’s Hospital, Albany.

Hodgson received her Master’s Degree in Health Services Administration at St. Joseph’s College in Maine. Hodgson recently completed the Patient Safety Executive Program at the Institute for Healthcare Improvement in Cambridge, Mass.

CNA Publishes New Guide to Reducing Falls In Hospitals

New Publication from CNA Addresses Patient Falls

CNA HealthPro understands the importance of patient safety and risk management in the evolving world of healthcare. CNA HealthPro researches and analyzes healthcare liability trends to create resources to help its clients manage a variety of healthcare risks.
They have published a new resource to help ambulatory-based facilities learn how to reduce patient falls, which are a common yet, highly preventable, source of injury and litigation. 

InBrief(R) entitled, "Patient Falls: Assessing Risk, Reducing Injury," provides general strategies to reduce and document falls within ambulatory care settings. These strategies can be customized to reflect organizational needs and risk exposures. According to CNA HealthPro data, approximately half of the fall-related ambulatory care claims were asserted against home healthcare companies, mostly by clients receiving assistance with daily living activities. 

CNA is the country's seventh largest commercial insurance writer and the 13th largest property and casualty company. CNA's insurance products include standard commercial lines, specialty lines, surety, marine and other property and casualty coverages. CNA's services include risk management, information services, underwriting, risk control and claims administration. For more information, please visit CNA at www.cna.com . CNA is a registered trademark of CNA Financial Corporation. 

For more information on Patient Safety and Fall Prevention

PharMEDium Services Launches New Website Which Provides Updates on Patient Safety

PharMEDium Services, LLC, has launched their new website, www.pharmedium.com, which now provides updates on drug shortages, patient safety and ready-to-use pharmacy compounding services.   The PharMEDium website design provides information necessary to facilitate a hospital's selection of compounded sterile preparations and demonstrates the qualities to look for when assessing a possible outsourced pharmacy sterile compounding service provider.Hospital customers can easily obtain valuable information on PharMEDium's broad range of services designed to reduce waste, improve efficiency and enhance patient safety.


Amy Langan, VP of Marketing and Business Development, commented, "PharMEDium's new website demonstrates our ongoing commitment to improve on our customer service experience providing innovative customized pharmacy sterile compounding solutions to the market we serve.  We conducted extensive customer research to ensure that our website design and development met the mark for enhancing patient safety.  We succeeded by making valuable service information easier to locate, use and refer to at the touch of a key."

Central to PharMEDium Services is www.pharmedium.com, where convenient online ordering for customers resides.  Online ordering has been propelled to the next generation by the establishment of the Controlled Substance Online System "CSOS" for ordering DEA Schedule II Controlled Substances.

PharMEDium is the national leading provider of customized pharmacy sterile compounding for hospital intravenous and epidural therapies. The PharMEDium network of state licensed and federally registered compounding centers provides trusted solutions to hospitals throughout the United States. PharMEDium complies with all applicable state laws and FDA regulations, including USP Chapter (797), and DEA requirements.  For more information on PharMEDium, visit www.pharmedium.com.

AtlanticCare Regional Medical Center Selects Talyst Pharmacy Automation System

AtlantiCare Regional Medical Center's Atlantic City Campus has selected a new enterprise-class software and hardware components by Talyst.The pharmacy automation deployment will improve patient safety and inventory control across its health system.

The automated technologies by Talyst will manage the complete pharmacy inventory from arrival in the pharmacy to the patient care area. At Talyst, one of our main goals is developing automated technology that helps eliminate medication errors," said Carla Corkern, Chief Executive Officer at Talyst. "We are committed to our customers and dedicated to delivering high-level enterprise class solutions."

"We continuously assess our dispensing processes and are always seeking ways to further enhance the quality and safety of our medication delivery to support patient care," said Pete Venuti, Director of Pharmacy Informatics at ARMC. "Talyst's products assist with pharmacy inventory control and support our high standards in regards to medication safety."

For more information on medication safety please visit Patient Safety & Quality Healthcare

Patient Safety Technologies Reports More Hospitals Using SurgiCount Safety Sponge

Patient Safety Technologies  Inc. announced financial results for its second quarter of 2011 ended June 30, 2011.


Financial Highlights
During the second quarter of 2011, the number of institutions using the Company's SurgiCount Safety-Sponge® System surpassed 70. This compares to approximately 52 institutions using the solution at the end of the second quarter of 2010.
Total revenue for the quarter ended June 30, 2011 was $2.6 million, which included $0.5 million of revenue from the delivery to the Company's exclusive distributor as part of a $10.0 million inventory stocking order.  Excluding the effect of this inventory stocking order, revenue for the quarter ended June 30, 2011 was $2.1 million.  This compares with total revenue for the quarter ended June 30, 2010 of $3.8 million, which included $2.3 million of revenue from the delivery under the same $10 million inventory stocking order.  Excluding the effect of this inventory stocking order, revenue for the second quarter of 2010 would have been $1.4 million.  Accordingly, excluding the effects of this inventory stocking order, revenue for the three months ended June 30, 2011 of $2.1 million represents approximately 50% growth over the $1.4 million generated for the three months ended June 30, 2010.

This growth in revenue excluding the effects of the stocking order is primarily the result of the significant growth in the number of hospitals using the Safety-Sponge® System at the end of the second quarter of 2011 as compared to the second quarter of 2010.  Additionally, during the second quarter 2011, the Company successfully completed the delivery of the last of the $10.0 million stocking order.

About Patient Safety Technologies, Inc. and SurgiCount Medical
Patient Safety Technologies, Inc., through its wholly-owned operating subsidiary SurgiCount Medical, Inc., provides the Safety-Sponge® System, a solution proven to improve patient safety and reduce healthcare costs by preventing one of the most common errors in surgery, retained foreign objects.  For more information, contact SurgiCount Medical, Inc. at (949) 387-2277 or visit www.surgicountmedical.com.

For more information on patient safety and avoiding retained surgical instrument errors please visit Patient Safety & Quality Healthcare

Monday, August 15, 2011

Barcode Technology for Positive Patient Identification Prior to Transfusion

This article was published in the July/August issue of Patient Safety & Quality Healthcare

In today’s highly demanding clinical environment introducing a new technology is challenging under the best of circumstances. What if, right when roll-out is going well, an unrelated connectivity interruption leads nurses to conclude “this doesn’t work”? You will need to get the new initiative back on track—especially when it impacts improving patient safety. How do you meet your end-users’ needs, protect your hospital’s considerable investment, get the positive results leadership expects, and, most importantly, help improve patient safety and quality of care?

Saint Joseph’s Hospital of Atlanta in Atlanta, Georgia, (Saint Joseph’s) faced exactly this challenge, just days after go-live with a positive patient identification (PPID) software platform that had been carefully evaluated and selected to help improve blood transfusion safety. After the software platform and mobile barcode devices had been successfully installed throughout the hospital, modifications to the hospital’s wireless network caused significant connectivity issues for more than 10 weeks. Although not device-related, nurses perceived this problem as a product failure and were reluctant to change from their manual method of transfusion administration.

To read the full article please visit Patient Safety & Quality Healthcare

Healthcare Technology Foundation Surveying Perception of Clinical Alarm Problems

The Healthcare Technology Foundation is conducting a re-survey of the healthcare field to determine changes in the healthcare profession's perception of clinical alarm problems, improvements made at their facilities, and priorities for future action. The survey is co-sponsored in part by the Association for the Advancement of Medical Instrumentation with many collaborating organizations.


Please help address this important issue by distributing this call for participation to appropriate staff in your institutions. The survey can be accessed at
https://www.surveymonkey.com/s/DND8PVW

The survey ends on September 7, 2011.
If you require a hardcopy survey, click here to download the survey. Save/Scan and return to info@its.uvm.eduThis e-mail address is being protected from spambots. You need JavaScript enabled to view it , fax to 802 656-8561, or mail to:
HTF
5200 Butler Pike
Plymouth Meeting, PA 19461-1298

Completed hard-copy surveys must be received by September 2, 2011.
Your contribution is critical to the improvement of clinical alarms-related issues, a subject that will be addressed at the forthcoming Alarms Summit (http://www.aami.org/alarms/index.html)

To read more about alarms and patient safety please  visit Patient Safety & Quality Healthcare

AHRA and Toshiba Announce Patient Safety In Imaging Grants

To help hospitals and imaging centers build new or expand upon existing education and patient care initiatives, AHRA: The Association for Medical Imaging Management announces the fourth year of its Putting Patients First Program. Putting Patients First grants provide healthcare facilities with the resources needed to improve imaging quality and safety for patients and are funded by an unrestricted educational grant from Toshiba America Medical Systems, Inc.

The AHRA & Toshiba Putting Patients First Program provides six grants of up to $7,500 each to hospitals and imaging centers and an additional grant of up to $20,000 to an Integrated Delivery Network (IDN) to fund programs, training or seminars aimed at improving patient  safety in CT, MR, Ultrasound, X-ray and Vascular imaging. Three of the $7,500 grants will be awarded for projects that improve the safety and comfort of pediatric imaging, while the other three will be awarded for projects that improve overall patient care and safety in imaging. The new grant of up to $20,000 will be awarded to an IDN or hospital system for projects that improve overall patient care and safety in imaging across the IDN/hospital system. All winning facilities will then develop and share their best practices.

To read full article please visit  http://www.virtual-strategy.com/2011/08/15/ahra-and-toshiba-expand-fourth-annual-putting-patients-first-program

Thursday, August 11, 2011

In Pursuit of a Patient-Centered VA Prescription Label

Published in the July/August Issue of Patient Safety & Quality Healthcare

By Erin Y. N. Narus, PharmD, RPh; and Joe D. Youngblood, RPh

The patient-centered prescription label movement has roots in primary research studies by notable health literacy proponents (Davis et al., 2006; Davis et al., 2008; Shrank et al., 2007; Sharnk, Avorn et al., 2007). This foundational work paved the way for setting standards for prescription label formats, content, lexicon, and numeracy interpretation. As the data mounted, consensus recommendations emerged in publications from the American College of Physicians Foundation (ACPF)(2007), United States Pharmacopeia (USP)(2010, 2011), National Association of Boards of Pharmacy (NABP)(2009), American Foundation for the Blind (AFB)(American Society of Consultant Pharmacists Foundation/AFB, 2008), and the Institute for Safe Medication Practices (ISMP)(2010), to name a few.

Each organization has played a critical role in the understanding of what it means to deliver a patient-centered prescription label. It is to these consensus guidelines that the VA, through a joint venture between the VA National Center for Patient Safety (NCPS) and VA Pharmacy Benefits Management (PBM), has turned in evaluating, redesigning, and testing potential standardized outpatient prescription labels. It is, to say the least, a considerable task, considering the VA serves more than 4 million individuals through both local VA medical center outpatient pharmacies and Consolidated Mail Outpatient Pharmacies (CMOPs)(Aspinall et al., 2009). Though the VA’s seven CMOPs provide mail-order prescriptions to veterans via highly automated distribution systems at strategic locations throughout the country, they lack a standardized label.

Implementing a consistent label format and style, therefore, could significantly improve the reliability of information transfer between the healthcare team and the patient by promoting a “shared mental model.” The concept of the shared mental model reaches across high-reliability industries and uses standardization to achieve the goal of error reduction (Sculli & Sine, 2011).

To read the full article please visit Patient Safety & Quality Healthcare

Wednesday, August 10, 2011

Patient Safety & Quality Healthcare feature RFID in Healthcare Showcase

Published in the July/August Issue of Patient Safety & Quality Healthcare

Patient safety event-reporting systems are found in all hospitals and are a mainstay of efforts to detect potentially critical events and quality problems. Initial reports usually come from the personnel directly involved in an event or the actions leading up to it, such as the nurse or physician caring for a patient when an error occurred, rather than management or patient safety professionals.

On January 19, 2009, regulations implementing the Patient Safety and Quality Improvement Act became effective. The legislation provides confidentiality and privilege protections for patient safety information when healthcare providers work with new expert entities known as Patient Safety Organizations (PSOs). The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) has also launched a multi-year effort to develop common definitions and reporting formats for patient safety events in order to facilitate aggregation of patient safety information.

to read the full article please visit Patient Safety & Quality Healthcare

Flagler Hospital Selects Allscripts Enterprise Systems to Improve Patient Safety

Flagler Hospital, ranked one of America's 50 best hospitals, has selected the Sunrise Enterprise suite of clinical and financial solutions from Allscripts. In addition to implementing Sunrise within the hospital, Flagler Hospital will endorse the Allscripts ambulatory Electronic Health Record (EHR) and practice management solution for its 130 affiliated physicians in the St. Augustine area.

"Our new partnership with Allscripts will help Flagler Hospital continue to enhance quality healthcare while delivering important new capabilities," said Flagler Hospital President Joe Gordy. "In particular, this initiative supports our long tradition of partnering with St. Augustine's community physicians by providing interoperability and two-way connectivity to the hospital, whether they use an Allscripts EHR, one from another company, or still practice on paper. That sets Allscripts apart from their competitors' closed systems, which would sharply limit the ability for our physicians to seamlessly share critical patient safety information across multiple systems."


After an extensive and highly competitive search, Flagler Hospital selected Allscripts in July 2011 based on the company's open, Microsoft-based technology platform, which reduces total cost of ownership and simplifies interoperability and connectivity with third-party systems such as EHRs used by community physicians; its history of high physician utilization at many of the nation's leading hospitals; and its record of strong health outcomes.

"To maximize patient safety and reduce unnecessary duplication of services during transitions of care, it's critical to have seamless connectivity between caregivers across the community," said Flagler Hospital Chief Information Officer Bill Rieger "Allscripts has the strong support of our clinicians, thanks in large part to its track record for delivering quality outcomes and high rates of physician utilization."

Tuesday, August 9, 2011

AllMed Healthcare Launches Peer Review Service for Hospitals

AllMed Healthcare Management, an innovator in the development of web-based medical review workflow software, announced the launch of its online external peer review services for hospitals and ASCs through PeerPoint©. Effective immediately, hospitals, ASCs and others can send, track and receive their physician case reviews online, enabling them to further enhance quality of care with greater efficiency and at lower cost.


AllMed has deployed its external peer review services onto the PeerPoint platform, enabling all services to be performed securely through the portal.  AllMed’s external peer review services allowing hospitals and ASCs to perform in-depth evaluation of sentinel events, credentialing or re-credentialing, privileging or re-privileging, proctoring and ongoing measuring and monitoring of physician performance.

To read full article please visit Patient Safety & Quality Healthcare

ABMS Announces New Patient Safety Award

The American Board of Medical Specialties (ABMS), the organization overseeing the certification of physician specialists in the United States, announces the creation of an award for a distinguished national leader in Health Care Quality and Patient Safety. The ABMS Board of Directors approved this new award at its June 22 meeting and the first Call for Nominations for the award went out July 5.
This award will be given for extraordinary national or international contributions to the fields of quality healthcare and patient safety, with a particular focus on physician performance, professionalism and the improvement of clinical performance. The ABMS Board of Directors will be seeking nominations annually, but may choose not to make an annual award.

To read the full article please visit Patient Safety & Quality Healthcare

Monday, August 8, 2011

3M Infection Prevention and RL Solutions Provide Real-Time Infection Rate and Cost Data Associated With Healthcare-Acquired Infections

3M Infection Prevention and RL Solutions announced a joint feasibility program to provide healthcare facilities data on the rate of hospital acquired infections in real-time and the costs associated with those infections. This collaborative effort brings together RL Solutions' leading infection surveillance system, RL6:Infection, with the 3M(TM) HAI Cost Analysis Report, which gives hospitals and healthcare facilities the ability to track the cost of healthcare-acquired infections (HAIs).


3M HAI Cost Analysis Report combines software and services -- merging infection information and administrative (coded) systems -- to highlight the financial ramifications of HAIs, while giving hospitals the ability to develop business cases to support infection prevention initiatives.

The program fits into 3M Infection Prevention's mission of developing solutions to minimize the risk of HAIs, which, according to the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services report, are the most common complications of hospital care and one of the top 10 leading causes of death in the United States. By consistently gathering important metrics through the dual emphasis on data and cost associated with HAIs throughout the hospital, the new solution allows infection preventionists to apply the same degree of rigor to every aspect of infection control facility-wide.

To read full article please visit Patient Safety & Quality Healthcare

MedStar Health Forms National Center for Human Factors Engineering in Healthcare

MedStar Health has announced the formation of the "National Center for Human Factors Engineering in Healthcare," a unique scientific research center that applies safety science methods to healthcare. The mission of the center is to improve patient safety, identify and test ways to better protect patients from harm and help create a safe care environment at MedStar Health and beyond.


The National Center for Human Factors Engineering in Healthcare utilizes the same safety science that has created dramatic improvements in safety in other domains -- specifically in the military and in the aviation, transportation, and nuclear energy industries. The Center applies these methods to all aspects of healthcare: to medical devices and instruments, to systems and processes of care, and to the overall work environment.

To read full news release please visit www.psqh.com

Leapfrog Group Will Include Nurses Role in Patient Safety in their Annual Survey of Hospitals

The Leapfrog Group will publicly report on hospitals that have demonstrated nursing excellence on Leapfrog's annual hospital survey. This is in response to a number of studies that have shown that nurses play a key role in patient safety. Making the announcement at AARP's Champion Nursing Council and Coalition Meeting in Washington, D.C., Leapfrog's CEO Leah Binder stated, "With this addition to our annual survey, Leapfrog is recognizing the vital role nurses play in patient safety and their strong commitment to transparency. As I visit hospitals across the country, I am constantly finding that the highest performing hospitals, many of Leapfrog's Top Hospitals, have earned the prestigious recognition of Magnet® and nurses are the most vocal supporters of making patient safety and quality information transparent. Our employer members value this designation, and its implications for safety, and believe hospitals deserve recognition when they achieve it."

The 2011 Leapfrog Hospital Survey data is publicly available.

For more information on patient safety please visit Patient Safety & Quality Healthcare