Beacon programs offer hope for health IT
Filed under: Government, Health care reform, Health policy, Hot Health Headline
Emma Schwartz and Fred Schulte, the HIT specialists at the Huffington Post Investigative Fund, examine the 15 “beacon” programs involved in a $220 million federal effort designed to demonstrate how health tech can bring better treatment at a lower cost. Twelve of the programs will focus, at least in part, on diabetes in order to explore how much of an impact HIT can have on chronic (and under-treated) diseases.
For more on each program, visit this interactive map.
The grants also offer an early test of a $27 billion gamble by the Obama administration that medical records technology can achieve specific cost reductions and health improvements, critical tenets of health reform.
Hopes are high. In Mississippi, the alliance aims to reduce blood sugar levels in at least one of four patients with diabetes, increase the numbers of people who take their medications as directed and cut the cost of their care by 10 percent – all within the next three years. In Tulsa, Okla., which has the nation’s highest rate of heart disease, another group is hoping that its $12 million grant will reduce preventable hospital visits by 10 percent while saving patients and taxpayers $11 million a year.
Schwartz and Schulte write hopefully of the potential shown by the beacon programs, but temper it with cautionary tales from Florida and various auditor’s offices.
Hospital sends ER wait times via text
Edward Hospital in Naperville, Ill., has taken the art of making ER wait times available to prospective patients to the next level, the Chicago Tribune’s Julie Deardorff reports. The hospital, which markets itself as “For people who don’t like hospitals,” has worked to decrease “door to doctor” wait times and are now making it as easy as possible for patients to know just what those wait times are. Folks can get up-to-date wait times online, over the phone or by text message.
A sign in the ER at Beth Israel Deaconess Medical Center in Boston. Photo by kbrookes via Flickr.According to the hospital’s site, these wait times are “the average time from when a patient arrives and checks-in at our ER to the time when they are placed in a room and treatment begins. The times are updated every 15 minutes based on actual times from the preceding 30 minutes.”
When I tested the service, texting “ERwait” to 41411, I got the following response:
Edward ER Wait Times: Naperville ER 2 minutes/Kids’ ER no wait, Plainfield ER 1 minute, visit us at www.edward.org/ERWaitTimes
It seems effective enough, though I have to wonder just how many people in need of emergency medical attention are going to have the number and requisite text handy.
You might recall that HealthLeaders Media wrote in January about the increasing number of hospitals that post wait times on their websites.
Why ER wait times are all-important
In a recent and conveniently relevant blog post, veteran South Carolina ER doctor Edwin Leap (bio) described how lengthening wait times can bring an emergency room to a “screeching halt.”
At that point, a helplessness descends on the nursing and physician staff. Wait times creep from two hours to four, four hours to eight, eight hours to ten. Only those who are obviously the sickest come back for care. Remarkably, on some of the busiest shifts ever, I discover that I have seen the fewest patients. If the pace were like normal, I could burn through ER visits like crazy; so could my partners. But when the numbers waiting climb, when the patients being admitted and held grow to legions, then speed is dead.
These are the dangerous times. These are the times when the sickest sometimes give up and go home. And the times when overwhelming amounts of data crush clear thinking.
It’s an evocative picture and one that Leap characteristically blames on the mission creep suffered by ER departments around the country. His laundry list of the extra responsibilities crushing today’s emergency rooms — “chronic pain” sufferers shopping for pills, constant chest pain and cardiac care, and basic primary care — should be familiar to anyone familiar with emergency medicine issues, but there were a few that stood out. The most telling was his rant about ERs as mental health facilities.
Mental health holding centers. A private, nationally known chain of mental health centers used to advertise: ‘if you don’t get help here, get help somewhere.’ That is, the ER. Call a suicide hot-line and you’ll be directed to an ER. It doesn’t matter that many facilities (like ours) don’t have psychiatrists or even counselors (except by tele-psych). It doesn’t matter that they take up beds, languishing in line for commitments (which seem to be growing exponentially in number). It doesn’t matter that the law requires us to pay one on one observers (and if they are RN,’s they get RN pay to read novels at $25/hour). It doesn’t matter that we don’t have the security to manage it. We are the last common pathway, so that someone, somewhere can feel good that ‘at least he’s finally getting the help he needs.’ No, he isn’t. He’s getting observed and largely ignored until we can send him somewhere else.
Leap always writes with a chip on his shoulder, but it reaches a crescendo when he decries the role of ERs as “guilt assuaging centers” for fellow physicians.
Call any doctor’s office. ‘If this is an emergency, hang up and dial 911.’ All you need to do, to do the right thing, is send someone to the ER. No matter how many stretchers are lined up in the hall, or how many schizophrenics or arrested drunks are screaming and terrorizing the little children with fevers.
Even when taken with a grain of salt, Leap’s writings bring across the chaos and urgency of the emergency department and highlight the way that it all revolves around that one magic number: The wait time.
Hensley explores HIT-related privacy breaches
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Studies
NPR health blogger Scott Hensley writes that the HHS’ running list of “breaches of unsecured protected health information affecting 500 or more individuals” reads like a sort of police blotter for health wonks, and explores a few of the more interesting cases.
Related: FDA committee recommends anonymous HIT error database
As expected, the FDA’s Health IT Policy Committee endorsed a database to confidentially record reports of HIT-related errors. A few months, another committee and the Office of the National Coordinator still sit between the recommendations and action.
Schulte, Schwartz look for help investigating HIT
Filed under: Health data, Health journalism, Hot Health Headline
Regular readers know that we always keep an eye out for updates from Fred Schulte and Emma Schwartz, the duo from the Huffington Post Investigative fund that refuses to let the Obama administration’s push for health information technology proceed without scrutiny. This time, they’re following up on past work with stories on HIT-related errors and the FDA’s role (or lack thereof) in the policing of HIT.
Their most interesting update, however, concerns their effort to get HIT-related “adverse events” data from the FDA. Schwartz describes the difficulties they’ve run into, how they’ve overcome them, and how readers can help them put the whole puzzle together. It’s an interesting strategy, and an equally interesting primer on the FDA’s tricky “Manufacturer and User Facility Device Experience,” or MAUDE, database. You can also find their own version of the data here, courtesy of Amanda Zamora.
Attending Health Journalism 2010?
Schulte will be speaking about “Tracking health-related stimulus money” during a panel at 4:15 p.m. on Friday. His co-panelists will be ProPublica reporter Michael Grabell and Phil Galewitz, a Kaiser Health News reporter and AHCJ board member.
On Sunday morning, don’t miss the panel “Personal electronic medical records: What will consumers need to know?” featuring:
- Steve Gray, partner, Affiliated Computer Services Healthcare Solutions
- Bala Hota, M.D., M.P.H., chief medical information officer, Cook County Health and Hospital System
- Thomas Layden, M.D., chief, Department of Internal Medicine; professor of medicine, University of Illinois at Chicago
- Moderator: Prerna Mona Khanna, M.D., M.P.H.. visiting clinical associate professor, University of Illinois College of Medicine
Report: Smart phones are changing health care
For the California HealthCare Foundation, Jane Sarasohn-Kahn created a 23-page report titled “How Smartphones Are Changing Health Care For Consumers And Providers (PDF).” The report’s key message is that, while doctors have been slow to adopt EMRs and other forms of HIT, they’ve been quick to adopt smart phones. And thus it would seem smart phone apps could hold the most promise of practical HIT implementation in the coming years. Especially since, Sarasohn-Kahn writes, Manhattan Research has found that “the number of physicians who own smart phones will increase from 64 percent in 2009 to 81 percent by 2012.”
The speed of the uptake has been remarkable for a nation that has been traditionally slow to adopt HIT, as Figure 1 shows. Two-thirds of physicians used smartphones in 2009. About 6 percent of these were using a fully functional electronic medical record or electronic health record system — while only 1.5 percent of hospitals had a comprehensive electronic health record system as of 2008.
And the promise and popularity of health on smart phones has led to a corresponding boom in apps, Sarasohn-Kahn writes. Right now, she says, “Some of the most widely used mobile applications by physicians are drug and clinical references, and clinical tools such as dosage calculators.”
For clinicians, the smartphone offers an alternative to many health IT formats that have been cumbersome and costly to adopt, and that may interrupt their workflow. As of February 2010, there were 5,805 health, medical, and fitness applications within the Apple AppStore. Of these, 73 percent were intended for use by consumer or patient end-users, while 27 percent were targeted to health care professionals. It should be noted that, although developers usually have a principal audience in mind, all users can and do download the apps. In the “medical” category, 33 percent of apps are meant for consumers/patients, 32 percent for physicians, 17 percent for medical students, 4 percent for other health professionals, and 2 percent for nurses.
In addition to her market statistics, Sarasohn-Kahn breaks the applications down into key categories, the most interesting of which are:
- Linking physicians to up-to-the-minute safety alerts on a local and national scale
- Delivering instant lab results
- Remote monitoring of patients and their vital statistics, as well as the issuance of related alerts
- Consulting with other physicians remotely
- Monitoring patient compliance with treatment recommendations and guidelines
Tracking medical errors amid health tech push
Filed under: Government, Health policy, Hot Health Headline
Fred Schulte and Emma Schwartz are still hot on the trail of health information technology at the Huffington Post Investigative Fund, now exploring the timeline and tactics involved in tracking medical errors as part of widespread stimulus-funded HIT adoption. Colleague Amanda Zamora’s companion graphic helps provide both an at-a-glance overview and in-depth understanding of how errors are tracked now and how they will be monitored in the future.
Schulte and Schwarz write that a federal panel hopes to create a national database of HIT-related errors, but that it won’t be functional until 2013, a date many experts fear is unnecessarily distant.
The draft proposal would require doctors and hospitals to report problems as a condition of receiving stimulus money, starting in 2013. The panel, which is expected to finalize the plan next month, also wants to require that manufacturers alert customers when software glitches are discovered and require all users of the systems to undergo safety training
…
But many early adopters, who often have spent a decade or more and tens of millions of dollars working out kinks, say that even additional oversight can’t stave off every potential hazard. And they are becoming increasingly vocal about the downside of rushing into buying the highly complex technology.
“There is a great fear among many people that we are asking organizations to go too far too fast,” said Justin Starren, who directs health technology at the Marshfield Clinic in Wisconsin. “It’s a foregone conclusion that with this many installations that some people will make some mistakes.”
Schulte will be taking part in a panel about “Tracking health-related stimulus money” at Health Journalism 2010. Joining him on the panel will be ProPublica reporter Michael Grabell and Phil Galewitz, a reporter for Kaiser Health News and member of AHCJ’s board of directors.
Patient data errors force VA to close EMR system
Nextgov’s Bob Brewin reports that errors in patient data have forced the Department of Veterans Affairs to close access to the Bidirectional Health Information Exchange, the Defense Department’s vast electronic medical record system. The bug first surfaced in February when a physician noticed that the system claimed one of his female patients had been prescribed an erectile dysfunction drug. The errors have been blamed on old code in the six-year-old system which could not handle peak usage rates.
The glitch did not cause harm to any patient, but “the potential exists for decisions regarding patient care to be made using incorrect or incomplete data,” said Jean Scott, director of the Veterans Health Administration’s Information Technology Patient Safety Office, in the alert issued on Wednesday.
… The VA clinician may see the patient’s data during one session, but another session may not display the data previously seen,” the alert noted. “This problem occurs intermittently and has been reported when querying DoD laboratory, pharmacy and radiology reports.”
The system is expected to go back online March 9. Until then, Brewin writes, “VA doctors will have to obtain a patients’ health information from their paper medical files, faxes or PDF attachments that are e-mailed to the physicians.”
According to its tagline, Nextgov focuses on “Technology and the Business of Government.”
FDA to regulate health information technology?
Fred Schulte and Emma Schwartz, the Huffington Post Investigative Fund duo who have made it their business to stay in front of all stories related to the federal push for the adoption of health information technology, now look at the possibility of federal regulation of health IT.
Schulte and Schwartz write that “In the past two years, the agency has received reports of six patient deaths and several dozen injuries linked to malfunctions in the systems,” and officials say those voluntary reports represent just the tip of the iceberg. In case you’re interested, here are the transcripts from the relevant government hearing.
… digital medical systems are not risk-free. Over the past two years, the FDA’s voluntary notification system logged a total of 260 reports of “malfunctions with the potential for patient harm,” including 44 injuries and the six deaths. Among other things the systems have mixed up patients, put test results in the wrong person’s file and lost vital medical information.
Schulte and Scwartz summarize the three possible regulatory approaches outlined by officials:
- Option 1: FDA requires HIT makers to register, submit safety reports and correct problems.
- Option 2: FDA requires HIT makers to report safety concerns and sets minimum quality guidelines.
- Option 3: FDA makes HIT “subject to the broader regulatory actions that new medical products must face before they ever reach the market.”
Many manufacturers argue that such regulation could be counterproductive.
The manufacturers of the systems generally have opposed regulation by the FDA, arguing in part that imposing strict controls would slow down the government’s campaign to spur widespread adoption of the technology.
Regulation will not necessarily create a “safer” electronic medical record “and might actually limit innovation and responsiveness when it is needed most,” Carl Dvorak, executive vice president of Epic Systems Corporation, a Wisconsin-based company that builds the systems mainly for hospitals and large medical practices, said in his prepared testimony for Thursday’s hearing. The hearing is being held by an advisory group created by the stimulus law.
Government Health IT also is following the issue and points to some problems the Veterans Health Administration has run into and how it dealt with the lapses.
FCC’s broadband plan includes wireless health tech
The Federal Communications Commission will release a report next month outlining a national broadband plan that is expected to include measures for promoting and facilitating the use of mobile devices in health care, Mary Mosquera of Goverment Health IT reports. The plan was mandated as part of the stimulus package.
The FCC plan will describe “where government has a role to reduce some of the hurdles to these technologies both in connectivity and to promote innovation in applications,” said Dr. Mohit Kaushal, digital healthcare director of the FCC’s Omnibus Broadband Initiative.
The American Recovery and Reinvestment Act called for the FCC to develop a plan for establishing broadband connections to the Internet as a way to spur business development, job creation and improvements in healthcare.
To demonstrate a few possible uses of such technology, Mosquera also talks to organizations, hospitals and doctors who are taking advantage of current resources.
Patient 2.0 empowers patients, worries doctors
Filed under: Health data, Hospitals, Hot Health Headline
Writing for Time, Bonnie Rochman digs into the ramifications of patients sharing information and tips online, an “empowerment movement” she calls “Patient 2.0.” In the piece, she profiles the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.
One private-sector initiative already has about 50,000 patients inputting their symptoms and treatment regimens and updating details of their disease progression. Wonder how others are coping with your particular ailment? PatientsLikeMe.com spells it out via color-coded charts and graphs. “When you need help, privacy is a terrible thing,” says Jamie Heywood, who co-founded PatientsLikeMe in 2004 before his brother died of Lou Gehrig’s disease, or ALS.
Rochman demonstrated the strength of PatientsLikeMe in an anecdote in which data from the site’s users allowed administrators to reach clear conclusions about the effectiveness of lithium in the treatment of ALS six months ahead the formal clinical trials that were testing the same thing.
While medical professionals like those at the Society for Participatory Medicine have embraced the patient power movement, “plenty of doctors are worried about the quality of the information that is being assessed as well as patients’ ability to understand it,” Rochman wrote. A few have taken it upon themselves to fill the gaps, banding together to weigh in on the effectiveness of certain off-label treatments via Twitter, and to produce patient seminars on the reasons for clinical trials and the efficacy of various treatments.
NCHS: Patient 2.0 most popular use of health tech by far
The National Center for Health Statistics recently (Feb. 2) released statistics for the first half of 2009 on “Health Information Technology Use Among Men and Women Aged 18-64.” The stats show that “searching for health information online” is still the only use of health information technology embraced by a majority of American adults.
The numbers:
- From January through June 2009, 51% of adults aged 18-64 had used the Internet to look up health information during the past 12 months.
- Over 3% of adults aged 18-64 had used an online chat group to learn about health topics in the past 12 months.
- Among adults aged 18-64, women were more likely than men to look up health information on the Internet (58.0% versus 43.4%) and were also more likely to use online chat groups to learn about health topics (4.1% versus 2.5%).
- From January through June 2009, almost 5% of adults aged 18-64 had communicated with a health care provider by e-mail in the past 12 months.
- During the first 6 months of 2009, 6% of adults aged 18-64 requested a refill of a prescription on the Internet, and almost 3% had made an appointment with a health care provider in the past 12 months using the Internet.
- Among adults aged 18¬64, women were more likely than men to request a prescription refill on the Internet (6.6% versus 5.3%), make an appointment using the Internet (3.5% versus 1.8%), and communicate with a health care provider over e-mail (5.6% versus 4.2%).
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