Archive for 2008

Healthcare Remedies in an Ailing Economy

December 23rd, 2008 by Melanie Matthews

Profitability strategies from 129 healthcare colleagues and their expectations for the Obama presidency contained in this new HIN white paper.

Healthcare Remedies in an Ailing Economy

December 23rd, 2008 by Melanie Matthews

Profitability strategies from 129 healthcare colleagues and their expectations for the Obama presidency contained in this new HIN white paper.

Few Five-Star Stays in Nation’s Nursing Homes

December 22nd, 2008 by Melanie Matthews

Last week CMS made good on its June 2008 promise to launch a star-based ranking system of America’s 15,800 nursing homes that participate in Medicare or Medicaid. The initial evaluation revealed some quality gaps — nearly a quarter of facilities received only a one-star rating. Facilities are assigned one- to five-star ratings based on three key areas — health inspection surveys, staffing information and quality of care measures. The ratings are publicly available and will be updated monthly. A nursing home may not be the only long-term care choice, and the updated Web site also includes links to information for community-based alternatives to nursing homes.

Choosing a nursing home for a loved one is a difficult and emotional decision. A facility's star ranking is only one aspect of the evaluation process, along with a thorough site visit and discussions with nursing home staff, residents and residents' families. We're betting it won't be long before CMS invites nursing home residents to rate their experiences the way hospital patients do via the Survey of Patients' Hospital Experiences. Read about a recent study of HCAHPS data that links patient satisfaction to quality of care.

12 Resolutions for Health in 2009

December 19th, 2008 by Melanie Matthews

The American Council on Science and Health (ACSH) has released 12 resolutions to stay healthy in 2009. Standouts include reducing stress by focusing only on those things over which you have control, and checking with your physician before undergoing any complementary or alternative medicine (CAM) practices to avoid injury or negative drug-herbal supplement interactions.

  • Avoid smoking—the leading cause of preventable risk.
  • Achieve and maintain a healthy body weight.
  • Don’t drink and drive.
  • Exercise regularly at an appropriate level.
  • Consume alcohol only in moderation.
  • Get regular preventive healthcare and checkups.
  • Protect yourself against sexually transmitted diseases.
  • Check “alternative” practices with your doctor.
  • Use seatbelts on every trip.
  • Keep your teeth and gums in good condition.
  • Install and maintain a smoke detector in your home.
  • N.Y. Times Year in (Healthcare) Ideas

    December 16th, 2008 by Melanie Matthews

    Healthcare innovations culled from the New York Times eighth annual "Year in Ideas" issue: airbags for the elderly, automated anesthesia, bubble wrap that never ends, Mahlangu handwasher (I think we built something like this at Girl Scout Camp), positive deviance to reduce the spread of MRSA, scrupulosity disorder and more. The whole article is worth a read for the ideas it may generate for your organization. (See "The Two-Tier Teacher Contract," a first look at pay for performance for educators.)

    And because we could all use a little cheering in this economy and because it WAS included in the list (Avian Dancing), we give you Snowball the Dancing Cockatoo:

    Will Investment in Health IT Pay Off?

    December 16th, 2008 by Melanie Matthews

    Can spending money on health IT save healthcare organizations money in the long run? In today's economic climate, it's anybody's guess, but two stories in this week's Healthcare Business Weekly Update offer some perspective. First, read about a new HHS AHRQ study demonstrating the cost-saving potential of e-prescribing — $845,000 per 100,000 patients per year and possibly more system-wide. Also, a CSC survey on hospital cost-cutting found that while most respondents have delayed or deferred future IT projects and halted existing IT expansions, a few hardy souls — about 15 percent — have accelerated IT efforts in the hopes that it will pay off in improved efficiency and quality of patient care.

    Also last week, a new study from Harvard Medical School showed a trend toward lower paid malpractice claims for physicians who are active users of EHRs. Read more about these survey results here.

    EHR Use May Help Lower Paid Malpractice Settlements

    December 12th, 2008 by Melanie Matthews

    Use of EHRs may help reduce paid malpractice settlements for physicians, according to a new study based at the Department of Ambulatory Care and Prevention of Harvard Medical School and Harvard Pilgrim Health Care, and might ultimately lead to lowered malpractice insurance premiums for EHR users.

    The study, which appeared in the November 24th issue of Archives of Internal Medicine, showed a trend toward lower paid malpractice claims for physicians who are active users of EHR technology.

    The study examined survey responses from 1140 practicing physicians in Massachusetts during 2005 about their demographic characteristics and the length and extent of their EHR use. These physicians' malpractice history was accessed using publicly available data from the Commonwealth of Massachusetts' Board of Registration in Medicine. The study team compared the presence or absence of malpractice claims among physicians with and without EHRs, including only claims that had been settled and paid.

    Overall, 6.1 percent of physicians with EHRs and 10.8 percent of physicians without them had paid malpractice settlements in the preceding 10 years. After controlling for potential confounding variables, there remained a trend favoring EHR use, although the result was not statistically significant. In a secondary analysis among EHR adopters, the authors found that 5.7 percent of more active users of their systems had paid malpractice settlements, compared with 12.1 percent of less active users. Small numbers of physicians in both groups led the authors to interpret the results with caution.

    The investigators speculate that EHRs may decrease paid malpractice claims for a number of reasons. EHRs offer easy access to patients' history, which may result in fewer diagnostic errors, improved follow-up of abnormal test results, and better adherence to clinical guidelines. In addition, the clear documentation of care allowed by EHRs can bolster legal defenses if a malpractice claim is filed.

    If this link between EHR use and lower malpractice payments is confirmed in further studies, malpractice insurers may offer lower premiums for practices that use EHRs, and there would be further incentive for physicians to invest in an EHR system for their offices. The federal government could also decide to offer subsidies for EHR adoption because they have been shown to reduce healthcare costs through a decrease in medical malpractice payments.

    13 Ways to Prevent Patient Harm Related to HIT

    December 11th, 2008 by Melanie Matthews

    Below are suggested actions from the Joint Commission to help prevent patient harm related to the implementation and use of HIT and converging technologies:

    1. Examine workflow processes and procedures for risks and inefficiencies and resolve these issues prior to any technology implementation. Involving representatives of all disciplines—whether they be clinical, clerical or technical—will help in the examination and resolution of these issues.
    2. Actively involve clinicians and staff who will ultimately use or be affected by the technology, along with IT staff with strong clinical experience, in the planning, selection, design, reassessment and ongoing quality improvement of technology solutions, including the system selection process. Involve a pharmacist in the planning and implementation of any technology that involves medication.
    3. Assess your organization’s technology needs beforehand (e.g., supporting infrastructure; communication of admissions, discharges, transfers, etc.). Investigate how best to meet those needs by requiring IT staff to interact with users outside their own facility to learn about real world capabilities of potential systems, including those of various vendors; conduct field trips; and look at integrated systems (to minimize reliance on interfaces between various vendor systems).
    4. During the introduction of new technology, continuously monitor for problems and address any issues as quickly as possible, particularly problems obscured by workarounds or incomplete error reporting. During the early post-live phase, consider implementing an emergent issues desk staffed with project experts and champions to help rapidly resolve critical problems. Use interdisciplinary brainstorming methods for improving system quality and giving feedback to vendors.
    5. Establish a training program for all types of clinicians and operations staff who will be using the technology and provide frequent refresher courses. Training should be appropriately designed for the local staff. Focus training on how the technology will benefit patients and staff, i.e. less inefficiency, fewer delays and less repeated work. Do not allow long delays between orientation and system implementation.
    6. Develop and communicate policies delineating staff authorized and responsible for technology implementation, use, oversight, and safety review.
    7. Prior to taking a technology live, ensure that all standardized order sets and guidelines are developed, tested on paper, and approved by the Pharmacy and Therapeutics Committee (or institutional equivalent).
    8. Develop a graduated system of safety alerts in the new technology that helps clinicians determine urgency and relevancy. Carefully review skipped or rejected alerts as important insight into clinical practice. Decide which alerts need to be hard stops when using the technology and provide appropriate supporting documentation.
    9. Develop a system that mitigates potential harmful CPOE drug orders by requiring departmental or pharmacy review and sign off on orders that are created outside the usual parameters. Use the Pharmacy and Therapeutics Committee (or institutional equivalent) for oversight and approval of all electronic order sets and clinical decision support alerts. Assure proper nomenclature and printed label design, eliminate dangerous abbreviations and dose designations, and ensure MAR acceptance by nurses.
    10. To improve safety, provide an environment that protects staff involved in data entry from undue distractions when using the technology.
    11. After implementation, continually reassess and enhance safety effectiveness and error-detection capability, including the use of error tracking tools and the evaluation of near-miss events.19 Maximize the potential of the technology in order to maximize the safety benefits.
    12. After implementation, continually monitor and report errors and near misses or close calls caused by technology through manual or automated surveillance techniques.19,20 Pursue system errors and multiple causations through the root cause analysis process11 or other forms of failure-mode analysis. Consider reporting significant issues to well recognized external reporting systems.
    13. Re-evaluate the applicability of security and confidentiality protocols as more medical devices interface with the IT network. Reassess HIPAA compliance on a periodic basis to ensure that the addition of medical devices to your IT network and the growing responsibilities of the IT department haven’t introduced new security and compliance risks.

    Complementary and Alternative Medicine

    December 11th, 2008 by Melanie Matthews

    According to the HHS, U.S. healthcare costs could amount to $4.3 trillion by 2017. To avoid this, the healthcare community is seeking alternatives to conventional medicine and healthcare. As of 2004, 36 percent of U.S. adults used some form of complementary and alternative medicine (CAM), and this week's DM Update showcases one such alternative therapy used for headache relief.

    53 Successful Ideas in Healthcare

    December 9th, 2008 by Melanie Matthews

    Not surprisingly, when we tallied the results of our fifth annual healthcare trends survey, most of 169 responding healthcare organizations told us that the nation's faltering economy had the greatest impact on operations in 2008. We see evidence of this daily: Just last week, the N.J. Department of Health and Senior Services awarded $44 million in healthcare stabilization fund grants to six financially distressed hospitals in our home state to help them maintain healthcare access in communities where services are threatened. N.J. Governor Jon S. Corzine said the grants would "provide temporary funding to hospitals that are the healthcare safety nets of their communities."

    Healthcare organizations everywhere are looking for ways to increase revenues and reverse healthcare trend. One example is Connecticut's attempt to reduce the costs of institutional care by transitioning 700 nursing home residents back to community living, a featured story in this week's Healthcare Business Weekly Update.

    Our survey respondents provided some other ideas, which culminated in a list of the 53 most successful healthcare programs in 2008. Get this list and a summary of survey results in a free white paper, Healthcare Trends in 2009: Economy Threat to Care Delivery.