As reported in Healthcare Informatics on Nov, 7th, "The Online Care service will aim to improve access by allowing Veterans to have online visits with their own providers, as well as multi-disciplinary care teams when needed, through the Internet. Using two-way video, secure text chat and/or phone, providers will be able to review patients’ clinical information, discuss symptoms, provide medical advice, and diagnose and prescribe medications as appropriate. At the end of each online consultation, a record will be captured automatically that the Veteran can share with appropriate healthcare providers, maintaining continuity of care."
This is great news for rural America and for our Veterans. In fact, last night it was reported that internet broadband services are to be provided to low income Americans for $9 per month. Amazing! After I heard that I said to my husband.. they're preparing for Telehealth and Telemedicine!
Wow, things are moving so fast it is becoming difficult to stay informed!
"Medicare Releases Patient Safety Ratings For Hospitals" October 17, 2011 by Jordan Rau, KHN Staff Writer,
Medicare released a new edition of their Hospital Compare website. New data evaluates hospitals on how often their patients suffer complications. This is a new effort to compare facilities on hospital safety ratings, including incidence of medical error and patient harm.
To find a hospital on the site, type in the city and state, click on the hospital name and then select the "Patient Safety Measures" tab at the left. Hospital Compare also gives patients the option of choosing several hospitals at once. The new data covers the period between October 2008 and June 2010.
Hospital Compare was originally designed to help consumers evaluate hospitals when they are planning an inpatient stay, however, it has not been widely used by patients. The American Hospital association's Vice President, Nancy Foster said, "We believe the data is fairly seriously flawed in the way it's calculated. When inaccurate data is out there, it both misleads the public and generates a lot of activity that is unproductive in the hospital."
It is hoped that this new version will provide more accurate insight for clinicians and consumers of health care services.
OK, I saw this image the other day on Facebook and found it to be quite humorous as I imagine children in school may find certain activities funny. Just like "Finding X," the truth is that clinical data and the growing availability of data contained in computerized databases are becomming essential for transforming data into information that can be used to improve quality of care.
It is also interesting that Clinical Informatics is now a subspecialty for Physicians and this fact implies that they are using data-driven, computer-assisted clinical decision support to provide care for their patients. According to Nancy Lorenzi, PhD, chair of AMIA's board of directors, "Clinical informatics blends medical and informatics knowledge to support and optimize health care delivery."
This marks an interesting tipping point for computer use by Physicians. "Doctors can decide what data are most useful in clinical decision-making, as well as the most efficient ways for data to be delivered and used by physicians."
There's just one detail worth mentioning ... industry has reported that Physicians were reluctant to use CPOE for meeting meaningful use criteria, now they're jumping the curve to clinical informatics? Seems that the "next generation" of doctors may be the first to adopt use of computer generated analytics.
I suggest that the announcement and implementation of ACOs and dissolving fee-for-service reimbursement methods may be primary drivers for adoption of clinical informatics by physicians. It will be interesting to hear their results and how it will improve care of patients.
...and let us not forget HITECH/HIPAA... Thoughts?
In a previous post, I wrote about the cost of Medicare and Medicaid services and associated efforts to prevent fraud - but that's not the only area where costs have escalated. I think it is generally agreed that healthcare costs have reached extraordinary levels in recent years, reaching almost 17% of the U.S. GDP. Even with these high costs it is sad to say that healthcare outcomes have not kept pace with the rising costs. In 2009 the IOM released this workshop summary, The Healthcare Imperative: Lowering Costs and Improving Outcomes (above).
An interesting perspective appears at the URL above form of an animpated graphic entitled, The Cost of Healthcare, Explore the rising costs and how to save $463 Billion.
The Plan reflects federal government priorities to help eligible providers become meaningful users of health IT; support implementation of the Patient Protection and Affordable Care Act (PPACA); protect individuals’ privacy; empower consumers with access to their health information, and support enhanced learning and innovation. The Plan, which was last published in 2008, has been updated to take into account the rapidly changing landscape of health IT and health IT policy. Since 2008, two major pieces of legislation have established an ambitious agenda and committed significant resources to health IT– the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the American Recovery and Reinvestment Act, and the PPACA. The HITECH Act addresses security and privacy risks as health IT becomes a more ubiquitous part of health care, and PPACA expands both public health care and private health insurance initiatives.
Thank you to George VanAntwerp for posting this graphic.. It caught my eye because much of what it says is true.. scary, but true.
Now healthcare is striving to improve patient outcomes with Meaningful Use of EMRs. Do they diminish or mitigate hazards? Is patient care of higher quality with use of the electronic patient record for care coordination or other needs? There has been much discourse, both pro and con, regarding EHR use for improved patient care, but few reports have surfaced until recently. Last month, The New England Journal of Medicine published a Special Article entitled Electronic Health Records and Quality of Diabetes Care, NEJM, August, 2011, Cebul, Love, Jain, et al.
EHRs were compared with paper-based records in a long-term regional collaborative. Results of the study suggest that
EHR sites were associated with higher levels of achievement of and improvement in regionaly vetted standards for diabetes care and outcomes.
This is one of the first studies to report on value and use of EHRs that enables quality patient outcomes. It will be interesting to learn if other long-term chronic conditions demonstrate higher quality outcomes. Stay tuned.
A recent article in Healthcare IT News described an industry trend to take clinical data captured at the point of care and use it to determine how providers and hospitals can best meet requirements for meaningful use, and decisions regarding participation in ACOs. In technology circles, this trend is described as "Business Intelligence (BI)" or "Knowledge Management (KM)."
I prefer to describe uses of BI or KM software as "Clinical Intelligence" that can be used to analyze patient trends using data collected at the bedside and data contained in the Patient's EMR. Reported trends in the HIT News article describe reasons to collect and analyze data including:
"Pay for Performance" or bundled payment models that require efficient delivery of high quality healthcare services that result in improved health outcomes, and
An exciting move into the world of "Predictive Analytics" (within reasonable levels of confidence).
Healthcare decisions are made based upon objective and subjective reports by patients.
Just like other industries, access to data isn't enough if the goal is improved health outcomes.
Provide the right data in a clinically intuitive manner that supports the user's need for the right information, at the right time, for the right patient
Tom speaks to the "loosely coupled" relationship of information and decisions that are efficient enough to provide information for more than one question. He says that the provision of information supports decision making, but doesn't always "lead to better decisions."
I read this and considered that the most important factor in achieving clinical intelligence is the "human factor" ... Technology in and of itself does not change the way healthcare is delivered. Physicians, Clinicians, Nurses, Therapists, et. al. make decisions based on the data they - or computers - collect from and about the patient. He continued by saying that business intelligence results will increasingly be achieved by IT solutions that are specific to particular industries and decisions within them."
Interestingly, Tom commented about my post and recommended another post from his HBR blog, What Medicine Can Teach Us About Decision-Making. In this post Davenport mentioned Jerome Groopman, a distinguished doctor in Boston and a writer for The New Yorker (and the author of several books, including the recent How Doctors Think). "... many medical errors result from "poor thinking"--incorrect diagnoses, unreliable heuristics, and so forth... CEO's and other senior executives make similar errors. The difference is that "hospitals convene regular meetings where all faculty and trainees--from the chief to the beginning medical student--revisit cases that had poor outcomes." Needless to say, such self-examination is rare in the corporate boardroom.
Consider that business performance management is a "close cousin" to clinical outcomes management, healthcare analytics, predictive analytics, or any other name du jour. Three simple concepts can form the basis of an intelligent data platform upon which sound clinical decisions can be made.
Capture: Is data captured in a format that is flexible enough to be used for decision making? With timely updates, accuracy, and availability with appropriate security from any mobile device?
Analyze: Does the software tool provide an easy to use capability that searches, categorizes, slices, and dices data? Does it also save reports and recommend similar searches?
Predict: Am I able to discern .. of the X number of patients admitted to the ICU each month over the past year, how many exhibited clinical factors indicating risk of Sepsis? What interventions were used to prevent progression?
An interesting but previously unknown fact was that the Veterans Health Information Systems and Technology Architecture, VistA, is actually a bundle of nearly 20,000 software programs originally written in the 70’s by physicians for physicians. Interestingly, the author reports that many of the big EMR vendors today benefitted from the Open Source VistA EMR software – such as Epic and Cerner.
VA Health Care can be looked upon as a standard for future medical successes. The author spoke to an analogy of comparing the VA System with Accountable Care Organizations.. He writes, “we don’t need, and don’t have time for, endless studies and pilot programs to show how it could be done. With only a few tweaks, the VA can provide us with a proven model because it was an ‘accountable care organization’ long before most health-care wonks had any such concept.”
As a former VHA Staff RN I can relate to the many examples of quality care given to veterans in Longman's book. How, as a nation, do we care for our military and their families? They put their lives on the line, the ultimate sacrifice, and deserve the best care possible. As a nurse, I witnessed care of an Army Veteran mother who gave birth to an 11 lb. baby without requiring a C-Section. Due to his size, was born with distocia in his shoulder but fortunately without damage to his upper brachial plexus nerves. Mother and baby were fine, Physical Therapy (PT) and time healed the wound. Another example is a veteran who experienced shoulder pain after dislocation and a compressed vertebral disk. Again, PT was provided with pain management and without surgical intervention; his pain was virtually gone in a short while. He now serves with the Army’s Airborne Elite.
As an RN educated in the style of western medicine and therapeutics, I would have thought an OB/Gyn provider would have quickly performed a Cesarean Section for a fetus that size. I also would have expected that the man with the shoulder and compressed disk problem would have undergone some type of orthopedic surgery.
These examples are shared with their possible alternatives because the private health system is incented to provide interventions for which they are paid (fee-for-service). In contrast, the VA is incented to keep veterans healthy over their lifetime, though preventative care, education, patient involvement, and at lower healthcare costs.
Through use of VistA for the past 20+ years, the VHA has access to longitudinal records of veterans that can be used to study what works and what doesn’t work for patients with specific conditions, given certain treatments.
These records provide excellent insight into evidence based medicine. In comparison to private health plans, VHA and clinical guidelines are developed using this data. that support the benefit of long term relationships between veterans and the VHA.
Considering the aging population, the progression and high incidence of chronic diseases, coordinated and continuous care is required. Unfortunately, with the multitude of software systems for the healthcare market (clinics, CAHs, etc.), the ability for Clinicians to view longitudinal care received by patients is not available.
In our current state of EMR adoption, lack of free-flowing data from provider-provider or hospital-provider, hinders accumulation of medical knowledge that educates and informs clinicians in the practice of medicine.
This brief commentary on the book and use of medical data by the VHA is an exemplar of how health data collectedover a long period of time, when analyzed in the context of disease and health conditions has the potential to predict which evidence becomes medical best practices.
Here are some thoughts regarding EHR adoption and cultural issues in healthcare. It's essentially a wicked problem (i.e. high social complexity). Click on the picture below to view the presentation in PowerPoint.