We have some Healthcare reform in the US but we are still challenged with a system that is failing to deliver results. This piece recently: America Ranks No. 1 for Over-Priced, Inefficient Health Care featured the chart from the Commonwealth fund
That ranks the US last in a group of 11 industrialized countries.
As he puts it:
There is one way America is clearly exceptional: we have a healthcare system that is dramatically more expensive than the rest of the industrialized world, but it doesn’t manage to make us any healthier.While the Affordable Care Act attempts to address access it does little to address the cost of the system and the inefficiencies. This does not require a reduction in premiums it needs to address the costs built in to the system that we are all paying for in on form or another
Dr Hans Duvefelt wrote this piece on the healthcare blog: A Swedish Country Doctor’s Proposal for Health Insurance Reform that draws on his personal experience in “socialized medicine, student health, cash-only practices and government-sponsored rural health clinic working for an underserved, underinsured rural population.”
His focus is as a primary care physician but most would agree this is one of the most challenging areas for reform with the shortage in clinicians and low reimbursement rates that is driving doctors out and certainly no encouraging our new generating of clinicians to dive into this essential area.
His main proposals center on basic services that are covered by a flat rate for populations
- Have the insurance company provide a flat rate in the $500/year range to patients’ freely chosen Primary Care Provider, similar to membership fees in Direct Care Medical Practices.
- Provide a prepaid card for basic healthcare, free from billing expenses and administration.
but importantly changing the responsibility and feedback on the cost from a central purchasing authority (the government for example) to the user themselves.
- Unused balances can be rolled over to the following years, letting patients “save” money to cover copays for future elective procedures.
And offers a pathway to specialty care with some appropriate oversight and appriroate levels of reimbursement.
- Keep prior authorizations for big-ticket items, both testing and procedures, if necessary for the health of the system.
- Keep specialty care fee-for-service.
These are clever suggestions and would do much to encourage the patient engagement that will be, as Leonard Kish stated
Patient Engagement is the Blockbuster drug of the century
He rightly points out that the current health “insurance” products are often poorly named – given that insurance that pays and copiers to identify diseases with screening but then stops short of paying to treat conditions and diseases when they are found through that screening. But most of all Insurance should be user driven and priorities and decision left in the hands of the individual and their clinician and not relegated to others who sit in offices emoted from clinical practice and focused on fiscal drivers not on care and quality fo life
Health insurance is not like anything else we call insurance; all other insurance products cover the unexpected and not the expected. Most people never collect on their homeowners’ insurance, and most people never total their car. Health insurance, on the other hand, is expected by many to be like a bumper-to-bumper warranty that insulates us from every misfortune or inconvenience by covering everything from the smallest and most mundane to the most catastrophic or esoteric.
His point about setting of priorities is important – no matter how you cut it there is no unlimited pot of money o resources to treat everything and everybody. These are difficult conversation and ripe for abuse by those with their own agenda’s through fear mongering and use of emotive terms like “Death Panels”.
None of this aspect of reform is simple but it needs to be addressed and included.
The United Kingdom’s National Health Service (NHS) may not be perfect but they have started this process of addressing the challenge of allocating resources in an open manner. They developed the the quality-adjusted life years measurement (QALY) out of the National Institute for Health and Care Excellence (NICE). There has been criticism and push back as there will always be but the concept and methodology use is not limited to the UK. While imperfect as Laozi (c 604 bc – c 531 bc) stated: A journey of a thousand miles begins with a single step
There is lots of detail in this piece and I would encourage you to go over and read it
Previously posted on HITConsultant
On a recent flight, I had my headphones on and the Rolling Stones’ “Satisfaction”
began to play.
It’s a song I have heard hundreds of times over the years, but I was struck by the difference listening to it with headphones made. With no distractions, I noticed the bass line, in time with the percussion, provides the perfect offset to Mick Jagger’s distinctively strained voice. It was a completely different experience than hearing the track play in the background of a movie or while at a restaurant. Being fully-immersed and listening only to that song allowed me to pick out and appreciate subtle details I had never noticed previously. It’s no surprise that things sound differently when you’re able to concentrate your full attention on what is being said, but as I was sitting there, I became acutely aware of the function headphones serve—they enable the wearer to listen, blocking out distractions.
That is exactly what we are seeking in healthcare and it has proven to be difficult to achieve – in part because of pace, complexity of care, and technology. For centuries, physicians have listened to their patients and relied on their senses— their powers of observation— and matched these insights with clinical experience to heal. Clinicians need to be able to listen and concentrate on what their patient is telling them and noticing those distinctive symptoms he or she may be exhibiting. As Sir William Osler
Being able to dedicate your undivided attention to anything these days is a rarity, but in healthcare, it is a crucial but frequently missing element. The last thing you want to feel when you are at your most vulnerable is that your physician is multi-tasking. Patient satisfaction scores will suffer, but more concerning are the clinical risks and missed opportunities of distracted physicians.
Distracted clinicians are the result of what Dr. Steven Stack of the American Medical Association refers to as an “over-designed” health IT system.” In a recent discussion with industry leaders, he explained that we seem to have become victims of our own ambition. We have devised structures that don’t work for everyone and policies that create very real, very expensive consequences for those who don’t abide. And this has left physicians stretched too thin, trying to do more in less time without any direct impact on improving their ability to care for their patients.
So, maybe it’s time we scale back. Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center and co-chair of the nation HIT Standards Committee, noted that while we are in this period of transition and growth, we need to focus on parsimony, or determining the smallest number of moving parts that need to be adjusted in order to create seamlessness in HIT. Quite simply put, while the cart has been upset, there is no reason to trample all over the apples.
The MIT Technology Review recently interviewed Sarah Lewis, a doctoral candidate at Yale, about her recent book that explores how different unlikely circumstances or paths, like failure, have often spurred innovation. Citing creative geniuses such as Cezanne and Beethoven to Nobel laureates, she defines failure as the gap between where one is and where one would like to be. Confronting this gap, she asserts, is important because it “lets people go deep with their failure while letting it be an entrepreneurial endeavor if they like, or an innovative discovery.” We, in health IT, are currently at that gap where there is a disparity between where we are and where we would like to be.
The recent ICD-10 delay has provided the perfect opportunity for us to find Halamka’s parsimony, leveraging solutions that work for physicians and creating consistency and impact wherever possible. Like medicine itself, there will be no one perfect solution for every physician or organization, but we need to begin finding things that work – from re-skinning EHRs with easy to use tools like single sign-on or mobility to systems that respond to voice, touch or swipe to improve the experience for clinicians and patients. We need to start thinking of health IT more like headphones, coming in different styles to suit preferences, but providing the same function of reducing distraction and enabling the clinician to focus on the inflections in their patients’ voices, and truly hearing what is being said.
As Mick Jagger poignantly remarked, “The past is a great place and I don’t want to erase it … but I don’t want to be its prisoner, either.” We have accomplished a lot, but it is time to learn from the past and break free from what isn’t working. I think we can get health IT satisfaction (despite what the song says), but to do so we must all be engaged in the design, delivery, and re-imagination of healthcare and its intersection with technology. This truly is the art of medicine and we are all virtuosos contributing to the next masterpiece of healthcare.
I have the privilege of spending a lot of time on the road interacting with clinicians around the country (and world). I hear with too much frequency many doctors complaining about the Electronic Medical Record and how it fails to help them and in many cases makes their work harder. Some of this is a hangover from the past and the inadequate technology and in some cases hardware at the time In fact I’ve told this story a number of times that I can date to around 1995/6 and in this piece: Clinical documentation in the EHR
Many years ago, an excited friend who worked for one of the electronic health record (EHR) vendors at that time — it was really more of a billing and patient tracking and management system than an EHR — was desperate to show me some of their latest applications. In particular, a new module they had developed to capture clinical data. My friend pulled out his laptop, fired up the application, selected a patient and proceeded to enter blood pressure (BP). Some 20-plus clicks later, he had entered a BP of 120/80. While he was excited, I was dumbfounded. When it comes to patient care, doctors didn’t have time for 20 clicks to record BP years ago and they definitely don’t have that luxury in today’s demanding medical environment.
There is still some of that going on and not enough focus on the User Interface design and turning the technology into a barrier – this is the focus of the Art of Medicine campaign we launched some weeks ago
This article on Government HealthIT Are electronic health records already too cluttered? highlights a rising problem and one I hear about frequently. This is not just a healthcare problem and it is the focus of the work by Edward Tufte an American statistician and professor emeritus of political science, statistics, and computer science at Yale University who is well known for his books on information design which are bets acquired by attending one of his frequent courses on data visualization Here is a recent overview of visualization on the iPhone
He has a section on healthcare but many of his principles apply
For Brian Jacobs the problem was even more acute working in a Pediatric ICU:
The ICU is a very toxic and tech-laden environment….because of that, it offers the opportunity to make a lot of mistakes
As he points out much of the cutter derives form the multiple notes entered into the EHR every day. “It’s not uncommon in teaching hospitals to have six to seven notes per day on one patient, by the time the attending physician, residents, consultants, other doctors and fellows check on the patient.” So they instituted a policy of One Note per day
It’s actually one note per team per patient per day; one giant multi-contributor note. They still may be all writing their components, but it’s one note
With a template to hold the content generated each morning by the resident and then everyone contributing to that one note, adding and amending as necessary
So in addressing the issue clutter they also addressed usability and design turning the note into a living breathing document that is updated and maintained by the team that now takes care of patients But he addressed some other important issues – especially when it comes to quality of care and the quality of the medical note
Copy Forward is subject to some warranted scrutinyfrom a billing and audit standpoint. Much of the repetitive and “clutter” in the note comes form the copying forward of past information. But:
These notes should never be the same
And as part of that message they moved to an “End-of-day note” that was a fresh summary of the patient. Add to that an updated and well maintained Problem List and integration with the billing system to allow doctors to select their code for the work carried out that day and they moved to a valuable addition to the healthcare team in delivering quality healthcare with their EHR
EHRs are: more complete, legible, accessible and can be auto-populated and searched. They can provide diagnosis codes and they’re good for billing. On the other hand, they can sometimes lack quality information and are by far, too cluttered.
I said this back in 2003 (yikes!) – The Future of Technology is already here – Who’s on Board the train and who’s left at the station. I still believe it and understand that the technology does need to get better and be more integrated into the existing workflow
This Survey: Do Patients Really Care if You Use Your EHR in the Exam Room? was very revealing. It turns out contrary to the perception that the intrusion of EMR’s in the office patients prefer electronic documentation to alternatives
Most Patients Don’t Mind Electronic Note-Taking During Exams
In each case, more than 80 percent of respondents indicated they would not be bothered. On a sliding scale, patients indicated the least concern for doctors using tablets during the exam.
What was more surprising was the push back by patients on having scribes
But worst of all – recording devices
Ultimately, over one-third of patients said they’d be bothered by doctors using tape recorders to assist in charting medical notes. Specifically, patients at the furthest end of the spectrum—those who chose “would bother me a lot”—were more prevalent when it came to tape recordings than with any other method of charting during an exam.
There was a big preference to Electronic documentation at the point of care
They asked about reasons for dissatisfaction
Its not the technology that causes the dissatisfaction but in order of importance (for patients)
- long wait times at the doctor’s office,
- unfriendly staff
- short duration of visits with the doctor
- Trouble Scheduling Appointment
And coming in with a sliver of dissatisfaction at 5% “Doctor using a Computer in the exam room”
The main points highlighted
- The mortality rate fell by about 17 percent from 1968 through 2010, years for which we have detailed data…Almost all of this improvement can be attributed to improved survival prospects for males
- The surge in for 25- to 44-year-olds was caused by AIDS, which at its peak, killed more than 40,000 Americans a year (more than 30,000 of whom were 25 to 44 years old)
- AIDS was the single biggest killer of Americans who should otherwise have been in the prime of their lives (Sobering Statistic)
- 45- to 54-year-olds are less likely to die from disease, they have become much more likely to commit suicide or die from drugs
- How does suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise. (Suicide and has recently become the number one violent cause of death) – (Sad Statistic)
- The downside of living longer is that it dramatically increases the odds of getting dementia or Alzheimer’s
- The rise of Alzheimer’s and other forms of dementia has had a big impact on health-care costs because these diseases kill their victims slowly. About 40 percent of the total increase in Medicare spending since 2011 can be attributed to greater spending on Alzheimer’s treatment
They do a great job of slicing the data by cohorts of age groups showing how much we have improved mortality and how our 25 and under age group is benefiting from the health improvements with the lower mortality and higher life expectancy than any other cohrot
In an interesting post on the medscape site (subscription/registration probably required): The Pitfalls of Giving Free Advice to Family and FriendsShelly Reese described some of the challenges of giving medical advice
to friends and family (even if you are a wannabe Dr Phil).
As she puts it the path can sometimes lead to challenging areas of ethics and professional boundaries.
How do you address or deflect such requests? Unfortunately, there are no easy answers. It depends a lot on you, your boundaries, and the situation.
And she links to the AMA Guidelines
The American Medical Association (AMA) Code of Medical Ethics is clear, however: “Physicians generally should not treat themselves or members of their immediate families.” The statement goes on to provide an extensive list of good reasons why, including personal feelings that may unduly influence medical judgment, difficulty discussing sensitive topics during a medical history, and concerns over patient autonomy (Ref: American Medical Association. Code of Medical Ethics Opinion 8.19: Self-treatment or treatment of immediate family members. Issued June 1993.)
Some of the challenges of simple advice include
- Escalation to more complex or persistent advice
- Long distance diagnosis with missing data
- Lack of Doctor/Patient relationship and documentation
- Impaired judgement
- Changing and coloring of relationships
In one section she describes the challenges of dealing with family members and says
“I try not to give too much medical advice, even to my parents. I see my role as an advocate: to help them synthesize information when they have questions. When my mother calls and says, ‘I’m short of breath and I don’t know what to do,’ I walk her through all the things her doctor has talked to her about: Have you taken your blood pressure and pulse? Do you know how many times you’re breathing per minute?”
Good advice on being the patient advocate and healthcare manager for your family members (which many already are) In the end it boils down to personal judgement and your own boundaries.
Questions are appropriate and to be expected, Caplan says, but doctors have to wrestle with themselves in determining how to respond if they’re to act responsibly and ethically. “When close friends and family ask for medical advice, that’s always a matter for introspection, and at the end of the day, it’s not resolved by codes of ethics but by considered individual judgments.”
It used to be as the trusted source of knowledge where access to information was limited this was a significant responsibility but with the age of
and medical applications like AskMD, iTriage and HealthTap to mention a few you might find there is fewer and fewer requests. So for those of you that like the opportunity to help others out…enjoy it while you can mHealth and Telemedicine may be changing the landscape and soon!
HIMSS was exciting and despite the HIS Talk HISies awarding Google Glass the most over rated technology:
I know I am biased as one of the lucky Google Glass Explorer as can be seen in this post from MedCity Watching for Wearables at #HIMSS14:
I think they are wrong and its not just Glass that will provide better more ready access to essential clinical data.
Not to say that the initial program like many launches have had their problems with early releases of technology not quite ready for prime time – remember the 1987 Apple Newton:
Even the omnipresent iPad struggled initially – most have probably forgotten the initial lukewarm reception of the iPad
had Apple talking about a price reduction.
- Glass is socially awkward
- People get angry at Glass
- Wearing Glass separates you
and I would add Glass interrupts normal conversations and social behavior – but that is all now and like the mobile phone I believe it will be come a natural part of our technical fabric. Think back to 2007 and how pulling out a phone in a meeting was frowned upon – now it seems part of the fabric of many of the meetings I attend. But it was Mat’s commentary on the impact it had on his perception fo phones that really stuck out for me
Glass kind of made me hate my phone — or any phone. It made me realize how much they have captured our attention. Phones separate us from our lives in all sorts of ways. Here we are together, looking at little screens, interacting (at best) with people who aren’t here. Looking at our hands instead of each other. Documenting instead of experiencing.
Which resonates with me an the Art of Medicine campaign and the struggle clinicians have with focusing on the patient (To learn more, download the eGuide Art of Medicine in a digital world). As Dr. Edward C. Grendys, Jr. said in his article: There’s no room for technology in end-of-life care decisions:
From initial diagnosis through to surgical therapies, chemotherapy treatments and even end-of-life care, my job is to listen, assess and provide educated decisions that ultimately impact the health and wellness of another human being…. it’s my belief that when talking face-to-face with a patient about a care plan aimed at eradicating their body of a disease that threatens to take them away from their family, there’s no room for paper, computers and/or mobile devices. In these most intimate of conversations, the focus has always and must remain on the communication between the caregiver and the patient on the receiving end. That, in its purest essence, is what practicing the art of medicine is truly all about.
That’s not to say that Google Glass can solve this problem and in its current state and acceptance it might cause more challenges – but the potential is there to blend information access and capture into a physician patient interaction that remains all about the patient
Glass will provide improved access to essential clinical data to clinicians but as my friend Chuck Webster has pointed out on several occasions this is not just for clinicians. Patients are already accessing the internet in droves for clinical information, researching their conditions and that of their relatives and communities abound with resources and support for conditions from common to rare.
Before talking about some of the potential medical applications it is worth detailing the technology. Google Glass is basically a computer with 12Gb of memory attached to your head in the form of glasses. It has a heads up display with voice activation and has some apps that can be installed:
- Google Glass is basically a computer attached to a pair of glasses
- Google Glass has a display that is projected in front of the Right Eye that is a high resolution display equivalent of a 25 inch high definition screen from eight feet away
- Google Glass has a camera that points forward and can take pictures (5MP) or video (720p) that is closely aligned with the view you see from your own eyes
- Google Glass is voice activated using speech recognition to interact with the glass computer
- Google Glass works best when connected to the internet
- Google Glass Integrates with an Andorid Phone with a limited set of functions available for the iPhone
- Google Glass has no built in illumination so pictures or video taken in dark conditions do not work well
- The screen can be hard to see in bright light
There are many myths circulating:
- If someone is wearing Google Glass they are recording me
- False – The device is not set up to record continuously and will only record a video or photo based on an action by the wearer (either a spoken request
- OK Glass, take a picture
- or by pressing a button on the google glass device
- Once Someone Has recorded something on Google Glass it is Publicly Posted
- False – it requires an action on the part of the Glass owner to post the material to the internet otherwise it resides on the Google Glass device. It will be synchronized with the users Google+ account for automatic backup (much like photos are backed up from the iPhone to iCloud but like iCloud remain private to the user unless they elect to share them)
- Google Glass is constantly capturing data and transmitting it to the Internet
- False. Without an internet connection Google Glass simply stores any recorded information in the glass memory. And unless you have set it to record there is no data being captured
- Google Glass tracks users and unsuspecting bystanders
- False – Google Glass is not tracking or recording anything unless instructed to do so by the user
So who is using this technology, where are they using it and how are they using it in Healthcare. This articlecovered some of the early concepts and featured a short list of potential applications
- Video sharing and storage: Physicians could record medical visits and store them for future reference or share the footage with other doctors.
- A diagnostic reference: If Glass is integrated with an electronic medical record (EMR), it could provide a real-time feed of the patient’s vital signs.
- A textbook alternative: Rather than referring to a medical textbook, physicians can perform a search on the fly with their Google Glass.
- Emergency room/war zone care: As storied venture capitalist Marc Andreessen proposed in a recent interview, consider ”dealing with wounded patients and right there in their field of vision, if they’re trying to do any kind of procedure, they’ll have step-by-step instructions walking them through it.” In a trauma situation, doctors need to keep their hands free.
- Helping medical students learn: As suggested by one blogger, a surgeon might live stream a live — and potentially rare — surgery to residents and students.
- Preventing medical errors: With an electronic medical record integration, a nurse can scan the medication to confirm whether it’s the correct drug dose and right patient
In its simplest form just transmitting images in real time can offer some advantages for diagnosis – in Rhode Island they are planning on implementing Google Glass for the ED doctors to obtain real time consults with dermatologists.
And this from Kareo showing a patient education application that records the physician patient interaction and then makes it available afterwards for additional review:
In this case featured in the ER doctors use Google Glass and QR codes to identify patients which featured Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center which he talked about in his blog detailing their experience (oddly the articletalking about this refers to text that appears to have been changed or taken down):
When a clinician walks into an emergency department room, he or she looks at [a] bar code (a QR or Quick Response code) placed on the wall. Google Glass immediately recognizes the room and then the ED Dashboard sends information about the patient in that room to the glasses, appearing in the clinician’s field of vision. The clinician can speak with the patient, examine the patient, and perform procedures while seeing problems, vital signs, lab results and other data.
And this concept by the way was top of everyone’s wish list that I talked to in my unofficial survey of engaged and interested observers of my own pair. I’ll paraphrase
If I could get it to recognize someone and provide me with their name when I meet them that would be fantastic!
But it is in urgent care where there is so much potential:
This recent piece on Healium featured in the Seattle King5 News Station: Seattle Doctor testing Google Glass for Surgery in the ER (click on the link if the video does not show below to see it in action)
“If I want to look at for example radiology I can double tap ‘radiology…There’s his chest x-ray, it just popped up, oh he’s got a middle lobe pneumonia”
Part 2 will cover medical applications and how Google Glass technology can be applied in a busy clinical setting
Medicine is part science…. Part art.
The relationship between physicians and patients is at the core of healing. This begins with hearing and understanding. We want to reimagine healthcare—where physicians can get back to the art of medicine and were delighted to be joined by panelists:
Dr. Mark Kelemen, Senior Vice President, CMIO, University of Maryland Medical System Dr. Charles H. Bell, Vice President, Advanced Clinical Applications, Hospital Corporation of America (HCA) Stuart James, CIO, Sutter Health Dr. Andrew Watson, CMIO, University of Pittsburgh Medical Center (UPMC) (@arwmd)
The panel was moderated by our very own Dr. Paul Weygandt, Vice President, Physician Services, Nuance Keith Belton, Senior Director, Clinical Documentation Solutions Marketing, Nuance
and attended by some 50 attendees with varying backgrounds and perspectives
The underlying question:
How do return the focus to the patient. How can physicians navigate the changes and challenges of today’s complex healthcare environment while doing what matters most to them – listening and caring for patients?
The panel discussion addresses current physician frustrations with technology and what needs to change to keep them focused on patients and not data entry. It was clear that the physician’s voice and medical decision making is what matters most in practicing the art of medicine and how do physicians and patients both benefit?
We know from surveys that
- 36% of physicians say that EHRs interfere with face-to-face communication during patient care
- 80% of physicians say “patient relationships” are the most satisfying part of practicing medicine
- 28% of an average ER physician’s time is spent directly with patients
- and from a recent HIMSS session interesting Patients prefer doctors to have an EHR
Posting every patients Magnesium level multiple times in a note is not good clinical care #artofmedicine #himss14
One of our panelists asked the audience:
How many Docs would go to facility with no #EMR and used paper – no hands went up
One of the overriding concerns was the need for cultural change. The office or hospital based physician system is struggling to meet the patient needs today. They want to have the right nurse or physician there for them at the right time and indeed at the right place with telemedicine. It’s about cloud-based/consumer-based healthcare.
We need to get back to that local physician practice – with technology in the middle as a supporting actor but not the main event
Many physicians are in this field because we are trying to drive change but are struggling with the existing system that fail them. When I see a patient I have to review 10 systems, carry out at least 4 major systems examinations before I can submit a claim that properly reflects the care I delivered:
Dr Andrew Watson told the story of a patient under his care with a terrible antibiotic resistant infection that a patient developed in hospital and he was now under constant supervision adn intensive therapy. But as he said – he never needed to come into hospital – he could have been treated at home. Poignant reminder that Telemedicine is not just about reducing cost – it can be better for the patient and offer better results.
Dr Bell is waiting for the MIDI (musical instrument digital interface) moment so that he can plug into the medical record and go.
As a musician he remembers the implementation of the MIDI interface in the early 1980’s that allowed music manufacturers to create one standard that was royalty free and widely adopted for the benefit of the user musicians and the vendors. He wants that in healthcare – so do I.
Until we change the mandate on clinicians to document 8 of 10 systems to be fairly compensated for the care given
And importantly the concept of Bring Your Own Device (BYOD) is bringing functional tools into the healthcare setting and will/is revolutionize the care being delivered. As one panelist put it:
- We need strategies for bringing the focus back to the physician-patient interaction and removing impediments to that relationship
- Healthcare organizations should be and are encouraging/valuing physician professionalism
- This is about the changing face of healthcare – it’s not about technology. It’s about how we envision healthcare. How do we explain to providers that this isn’t about technology – this is about a new world order coming to healthcare
Come join the conversation at The Art of Medicine or come to the panel session Thursday, March 27, 2014, 9:00 – 11:00 am EST at the W Hotel,100 Stuart Street, Boston, 02116
The challenge of SGR “fix(es)” and the evolution of the systems we are implementing and the value proposition. As he put it
Quality of care is improved with better information — saving lives and money
But Health Technology is not easy to implement:
— Wen Dombrowski MD (@HealthcareWen) February 23, 2014And layered on top is the increasing challenge of securing the data with hackers seeing healthcare data as 15x more valuable than financialhacked data!
— HIMSS (@HIMSS) February 23, 2014What we need is coordinated care and Dr Wah offered this visual of the way forward
Christine Bechtel focused on the Activate Evidence Based Patient Engagementand as she reported – Patients like doctors who have an EHR
Patients think EHRs help doctors deliver better care
- Timely access to information, sharing info across care team, med history, managing health conditions
- Overall, EHRs were rated between 23%-37% points higher than paper on these elements
Interesting since doctors have been reported as saying they dislike the EHR but patients like seeing their doctors with an EHR
— HIMSS (@HIMSS) February 23, 2014 The sad thing was this session was concurrent with @ePatientDave in another room – The Connected Patient: Learning How Patients Can Help in Healthcare only social media united these sessions
— Susan Shaw (@drsusanshaw) February 23, 2014As for Jonathan Teich and his session Improving Outcomes with CDS- he used his personal experience where peer pressure (as he described it 3rd time he was pressured to take on an expert triple diamond ski slope) he finally agreed and ended up in a serious ski accident fracturing multiple vertebrae. Interesting analogy relative to the Clinical Decision Support System and the pressure this applies to clinical practice sometimes inappropriately… Interesting look at alerts and the potential for providing more than just alerts but actually providing intelligent data that distill down to 10 types of CDS interactions
- Immediate Alerts: warnings and critiques
- Event-driven alerts and reminders
- Order Sets, Care Plans and Protocols
- Parameter Guidance
- Smart Documentation Forms Improving Outcomes with Clinical Decision Support: An Implementer’s Guide (HIMSS, Second edition, 2011)
- Relevant Data Summaries (Single-patient)
- Multi-patient Monitors and Dashboards
- Predictive and Retrospective Analytics
- Filtered Reference Information and Knowledge Resources
- Expert Workup Advisors
And the important summary slide was the CDS Five Rights (Right information, people, formats, channels and times)
And returned to one of the core opportunities – Patient Engagement with a a session by Henry Feldman, MD FACP: Informatics Enabling Patient Transparency. He asked the same questions as another presenter – how many fo the audience considered themselves a patient (Still only a shabby 80%) and then took this further asking
- You feel that you know exactly what your provider was thinking in making his decisions
- You think the clinical systems helped your provider understand comprehensively everything about you
- You build clinical systems or are a provider
- With the inevitable decline in hands up
- You think your (or anyone else’s) software truly helps the patient or even the provider understand comprehensively or transparently what is going on
Sadly we are not near this and the reality is much further with physicians thinking patients are unsophisticated. Yes at he pointed out the airline industry gets it and even the DMV/MVA gets it offering customer engagement models: Their experience and stats blow the unfounded resistance out of the water
- Only 2% of patients found notes more confusing than helpful
- Only 2% found the note content offensive
- 92% said they take better care of themselves
- 87% were better prepared for visits
Importantly we need to turn data into information for patients and he cited the Wired example of a Laboratory test (Blood Test Gets a Makeover Steve Leckart) and the makeover for Basic Labs
and the PSA result
I know where I’d like to be receiving my care (and lab results) from! Great finish to the session. So as he summarized where we should be with patient engagement an data
- Open your data to your patients
- Patients understand more than we think
- Teach patients how to use data effectively – This can save you time in the long run
- Put your patients to work on their own health!
- Vendor work on how patients will view big data
- It’s a new drug, research the risks and benefits
Great start to what will be a busy HIMSS