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Major Healthcare Issues I Think IT Could Help Solve

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Yesterday and today I spent my time at the Accountable Care Expo in Las Vegas. It was a small intimate event, but those that were there were some really smart people who knew a lot about healthcare and about accountable care organizations. It was quite the education for me. Plus, as with most learning, as I learned more about ACOs I realized how much more I still don’t know.

During the conference I started to think about something I’d heard quoted quite a few times. At this conference they said, “3% of patients are consuming 60% of healthcare dollars.” I’ve heard a lot of different numbers on this. I remember hearing that 10% of patients have 80% of healthcare costs. Regardless of the exact numbers, I’ve heard this enough to believe that a small number of patients drive a abnormally large portion of the healthcare costs in this country.

When you think about this, it becomes quite clear that these “expensive patients” are likely those with chronic conditions. That’s the easy part. The harder part is that I’ve never seen anyone analyze the makeup of the 3-10% that are driving up healthcare costs. For example, what if 90% of those “expensive patients” are chronic patients over the age of 65. Solving this problem would be very different than if we found that 50% of expensive patients are diabetics under the age of 20.

How does this apply to health IT? First, health IT should be able to sort through all the big data in healthcare and answer the above questions. How is anyone going to solve the problems of these “expensive patients” if we don’t really know the makeup of why they’re so expensive?

Second, I believe that some health IT solutions can be implemented to help lower the costs of these chronic patients. I’ve seen a number of mHealth programs focused on diabetes that have done tremendous things to help diabetic patients live healthier lives. That’s a big win for the patients and healthcare. We need more big wins like this and I think IT can facilitate these benefits.

Since this post has taken a slight diversion away from my regular topics, I wanted to look at another thought I had today about healthcare. This tweet I sent today summarizes the idea:

All of the numbers I’ve seen indicate that hospitals are the most expensive part of healthcare today. Hospitals are just expensive to run. They have a lot of overhead. They work miracles regularly, but they come at a cost. While more could always be done, I feel safe saying that many hospitals have squeezed out as much cost savings they can out of the hospital. This means that in order to save money in healthcare we can’t strip more cost savings out of hospitals. Instead, we need to work to keep patients from going to the hospital.

There are a lot of ways to solve this problem (I heard of one payer putting instacare clinics next to ERs to save money), but the one I hear most common is the need for primary care doctors to have a more active role in the patient care. If they had a more active role once a patient is discharged from the hospital, then fewer patients would be readmitted to the hospital.

How then can we structure a program for primary care doctors to be paid to keep their patients from being readmitted to the hospital? That’s the million dollar question (literally). Everyone I know would happily pay a primary care doctor a half a million dollars in order to save millions of dollars in hospital bills. That extra money might also help us solve the primary care doctor shortage that I hear so many talk about.

I can’t say I have all the solutions here, and I don’t expect these things to change over night. Although, I think these will be important changes that will need to happen in healthcare to lower costs. Plus, I think IT will facilitate an important role in making these changes happen. Imagine something as simple as an HIE notifying a primary care doctor that their patient was admitted or discharged from the hospital. This would mean the doctor could go to work. Now we just need to find the right financial mechanism to be sure they act on that notification.

I’ll be chewing on these ideas this weekend. I look forward to hearing other people’s thoughts on these issues.

November 16, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Top 10 Medical Technology Hazards List – “Top 10″ Health IT List Series

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This next list I found in my series of Top Health IT lists is going to be one that I think surprises quite a few people. It’s the list (PDF) of Top 10 Technology Hazards for 2012 by the ECRI. The Power Your Practice website did an interview with James P. Keller Jr. who works at the ECRI Institute about this list which is worth reading. Before the interview, they explain that the ECRI (Emergency Care Research Institute) was created in 1964 after a young boy in a Philadelphia ER passed away as a result of an improperly preserved defibrillator.

For this list, I’m not planning to go through each item, but I will list each item:
1. Alarm hazards
2. Exposure hazards from radiation therapy and CT
3. Medication administration errors using infusion pumps
4. Cross-contamination from flexible endoscopes
5. Inattention to change management for medical device connectivity
6. Enteral feeding misconnections
7. Surgical fires
8. Needlesticks and other sharps injuries
9. Anesthesia hazards due to incomplete pre-use inspection
10. Poor usability of home-use medical devices

The PDF document above goes into a lot more detail for each of these items including suggestions on ways to prevent these problems. I imagine many hospital safety organizations already know about these things and lists like this one.

Many are probably wondering why I’m bringing this list up on an EMR and HIPAA website. Besides the fact that the list is interesting on its own, I was also really intrigued that there’s nothing on the list that’s even remotely related to EMR & EHR software.

I’m sure if we sat down for just a little bit we could think of quite a few technology hazards related to EMR and EHR software. Not the least of which is EHR down time. I’m also reminded of this post I did earlier this year titled “EMR Perpetuates Misinformation.” Yet, EHR didn’t make the list…yet(?).

It will be interesting to watch this health technology hazards list over time to see if EHR software ever makes the list. I wonder how many hospital patient safety groups are worried about the safety of EHR software. I’ll have to get Katherine Rourke to dig into this over on Hospital EMR and EHR.

Be sure to read the rest of my Health IT Top 10 as they’re posted.

December 29, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

A Trip to the ER: EMRs Aren’t Enough

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Guest Post: I got the following story that someone wanted to share about the challenges of EMR and workflow in a hospital. I love reading first hand experiences with EMR. Reminds me of a great experience that Neil Versel documented at an urgent care during HIMSS. I look forward to hearing your comments on the story.

Last month, my wife felt some discomfort in her chest. They weren’t pains, nor were they indigestion so much as a gurgling sensation. After two days and no change, she called our family physician. He told her she could come in for a blood enzyme test, but the lab result would take four days. Instead, he said to go to an ER where they could get the result in half an hour.

That evening, a Friday, we went to the nearest ER, at Large, Modern, Suburban DC hospital (LMSDC.) We walked right up to the triage nurse, a woman in her 60s who stood there and took down my wife’s info on paper: Name, Chief Complaint, Age, and Triage Class, a 3. We were handed the paper, the only copy, and sent to the first of what would be three exam rooms.

The room was for EKGs. It was equipped with a machine, bed, etc., and a desktop PC. After a few minutes, a tech came in and ran the test. I asked how the scan got into my wife’s record. She told us it was sent electronically to imaging where it would be reviewed and put in the record, but she didn’t know how it was entered, electronically or scanned in.

We had three more visitors, two nurses and an admissions clerk. Admissions came in with a COW, a computer on wheels. She started asking demographics, insurance, etc., but was called away. The first nurse came in went over why we were there, about meds, etc., took a blood sample and did something on the room PC and left.

The second nurse came in, went over symptoms, meds, etc., again, and scribbled the information on a scrap of paper in her hand. We never saw either nurse again. While waiting for the next step, I saw that the first nurse had logged into the PC, but not logged out.

We were then moved to a small exam area with five beds to wait for an attending and to wait for four hours until time for another blood sample. The area was run by a tech I’ll call Sam. Sam was a remarkable multitasker. Among other things, we saw him:
• Arrange patients and families in the cramped space
• Look for other staff
• Take blood
• Check orders
• Organize a stack of loose forms into their patient clipboards
• Change bed sheets
• Check the EMR for updates
• Check on patient moves

Sam did all this, and from what I could tell, was the only person who was actually followed the different aspects of his cases.

At first, the area was at capacity with crying children, their worried parents and others typical of a Friday night in an ER. While Sam directed traffic, the admissions clerk caught up with us and finished my wife’s record.

Around nine, an attending came in. He stopped midway in review for a half hour cell call and then returned. He recommended that she should go on a heart monitor and stay overnight. After the attending’s visit, we settled down to wait for a room. Sam checked every now and then to see where it stood, but it went nowhere.

About eleven, while making my second run to the ER vending machines, I saw the attending and mentioned that it was getting pretty boring waiting for a room and a monitor. Surprised, he said he’d ordered the monitor and that it should have been put on in the ER. With that, he checked with the charge nurse to get it done. The charge nurse came to see us and had us move to another area with a monitor, which a nurse started. Just after midnight, still waiting for a room, my wife sent me home. She called about one to say she’d been moved to a medical floor and was on a monitor.

I knew that LMSDC adopted an EMR three years ago and, indeed, it was clear that meds, complaints, orders, etc., were being entered into it. However, it was also clear that their system was a receptacle not a workflow tool. Apparently, LMSDC simply overlaid the EMR on its paper system, eliminating some parts, but keeping others. These other elements persist in their own parallel world. For someone such as Sam, who tries to keep his patients current it means more work not less. This explains why he had to deal with the EMR and constantly sort and organize paper forms into their proper patient clipboards.

Even that is not LMSDC’s major ER workflow problem. The heart monitor problem shows there is no shared task list. That is, once the attending entered the order, and I believe he did, the order is in the EMR. However, who is to carry it out and when should become a task that all others can see. Thus, the conversations among the attending, the charge nurse, Sam, my wife and me should have been unnecessary.

A couple of gratuitous points. LMSDC’s system is heavy on desktop machines. It cries for laptops or pads. Nurses, techs, attendings spend their time flying from one desktop to another, logging in and, sometimes, out. It’s a machine centric rather than a user centric system. Users never have their own workspace. They are always in hit and run mode. Even if they have a good system workflow and a good shared task list, they spend enormous time and energy logging in and out of room machines. It’s no wonder things get lost in the cracks.

LMSDC’s system runs both patients and staff ragged in another way. We moved three times, no record I expect. Nurses came and went. The attending should have been on skates. The only one with a dedicated space was Sam which explains why he could get so much done without exhaustion. How much easier their difficult lives and their patient’s lives would be if the patients came to the staff rather than endure the ER’s fast action minuet.

What’s so amazing is that despite their poor IT support and their constant motion, the staff was invariably professional, focused and friendly.

Best of all, after a night in the ER and a morning on a medical floor, my wife was discharged. She’s fine.

March 17, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.