Project offers road map to local health care innovations
A new, but time-limited – looks like the emails may just be going out for just for 30 days – resource has been pouring into my inbox faster than I can read it. It’s called Care about your Care, and it’s sponsored by the Robert Wood Johnson Foundation and a bunch of other groups (about 30 in fact: find the list here).
What questions do you have about health reform and how to cover it?
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
Part of the “Care” material is very consumer oriented- learning some of the basics about health care quality, such as “more is not always better” and how people can engage in their own care. That may help those of you who are trying to communicate the basics to your audience. There’s also a link to an RWJF site that pulls together in one place a lot of publicly available information about both cost and quality of care (people often ask questions about tracking down such data on the AHCJ electronic discussion list.)
But what really caught my attention about Care about your Care is that it’s a terrific road map to a lot of the innovation going on across the country, much of which hasn’t registered in the national media or in some cases even in the policy conversation. Some of the sites mentioned are Beacon communities – pace setters in using health IT to improve care. Some are part of RWJF’s Aligning Forces for Quality.
Looking though these Care about your Care alerts, I found a few initiatives that were particularly interesting because they brought so many difference branches of the community together – health care powerbrokers and local neighborhood groups.
Healthy Memphis: The Common Table, for instance, has programs ranging from diabetes control to encouraging farmers markets to training neighborhood health advocates who can then spread the work about quality care, including in low-income and underserved areas. Results can be measured: More people with diabetes are getting their blood sugar screened appropriately, the adult smoking rate has dropped, farmers markets are springing up, mammograms … well, maybe we shouldn’t go there.
So explore the site. Find out what’s going on in your state. And if the answer is nothing, find out why. Maybe you’ll discover that these ideas about quality and change are slowly begin to percolate, not just to “early adopters” aligned with groups like RWJF but through ordinary cities and towns. “Health reform” can be seen as more than a piece of legislation to fight about in Washington.
It is, potentially at least, a new way of thinking about, talking about, and doing something about both “health” and “care.”
Explain elements of health reform through the eyes, stories of doctors
In these posts about covering health reform, I usually don’t point to the big national dailies because a lot of people have already read those stories but a recent New York Times piece, “As Physicians’ Job Change, So Do Their Politics” is a story that may be able to help reporters think about a good local or regional jumping off point for telling aspects of the health reform story in a more narrative, accessible manner, through the eyes and experiences of doctors.
What questions do you have about health reform and how to cover it?
Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.
The Times story, by Gardiner Harris, described a shift leftward (or at least less rightward) among physicians. He cited several reasons: younger doctors, more female doctors, and above all more doctors who are salaried employees of hospitals instead of basically being small businessmen (or women) running a practice.
Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.
Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.
He wrote mostly about Maine, but had a few observations about other states, including Texas. Last year Texas physicians opposed the national health reform law by a three to one margin. But doctors who did not have their own practices were twice as likely to support the law. The same goes for female doctors.
How does a story about physician politics translate into a narrative about health reform?
The shift to salaried positions has many causes (including work-balance for doctors who want more time with their families) but the move toward more clinical integration and the formation of accountable care organizations or ACO-like entities will hasten this trend. It is really, really, really hard to explain ACOS clearly and concisely (when an editor of mine recently asked me to give him a nice, tight two-graf description, I began it something like, “One of the challenges of ACO is that they defy simple explanation.”)
But doctors who are joining hospital staffs or whose practices are being bought up by hospitals or who are entering different contractual relationships and affiliations with hospitals have stories to tell. You can also talk about quality measures and “never events” and how that affects physicians and the practice of medicine, particularly in states mandating more public reporting. Through their stories, you can illustrate what an ACO is or isn’t, or how a medical home works, or what “clinical integration” means.
I interviewed a physician in South Carolina the other day, Dr. Angelo Sinopoli, who told me about how the team approach and the use of electronic medical record with clinical decision support was giving him more real-time feedback on his own performance – and he welcomed it.
“You think you are doing something and you might not be, or think you might not be, but you are,” he said. “Seeing real data in as real time as possible made a difference in how we think.” That made me understand an aspect of the electronic medical record that I hadn’t understood before, and readers can grasp that too.
You can explore the changing attitudes and politics along with that – in some states that may be more significant than others, depending on what your state is doing with health exchanges, malpractice legislation, quality reporting etc.
Editor’s note:
Learn more about how electronic health records could mean new opportunities to improve clinical care and public health, according to David Blumenthal, M.D., the former national coordinator for health information technology. Blumenthal spoke at Health Journalism 2011 as he was leaving his federal position.
Audit: UK’s health IT program falls short of expectations
Filed under: Europe, Health care reform, Health policy
After a damning report from the U.K.’s national audit office indicating that the National Health Service’s massive health IT program has essentially been a black hole which vacuums up far more money than its lack of progress would justify, politicians are now calling for what amounts to the program’s termination.
Physicians support a national system of health records, but there seems to be a consensus that, in the current climate of British austerity, it may be time to amputate the program to stop the bleeding. After all, the audit indicated that despite a seven-year extension, it looks like the program has no chance of meeting its 2014-15 deadlines, or even of producing meaningful results. Here’s Polly Curtis in The Guardian.
The original aim of the £11.4bn NHS IT programme – to install a patient record database accessible from any point in the NHS in England by 2015 – will fail, the National Audit Office (NAO) warned.
The £2.7bn spent so far on the system has not been value for money, the watchdog said, adding it had no confidence that the remaining £4.3bn would be any better spent.
The nine-year-old project – the biggest civilian IT scheme attempted – has been in disarray since it missed its first deadlines in 2007. While its ambitions have been downgraded in recent years, the bill from the suppliers has remained largely unchanged, the report said.
How NASA came to work with a children’s hospital
Filed under: Children, Government, Hot Health Headline
Brian Ahier, writing for Government Health IT, tells the story of how NASA’s Jet Propulsion Laboratories ended up collaborating with Childrens Hospital Los Angeles on a seven-year project focusing on the detection of pediatric cancer through a “a collaborative approach to the discovery and development of early detection biomarkers.” It sounds like a goofy match but, when Ahier breaks it down, it’s easier to see how and why these strange bedfellows ended up together.
Photo by nasa1fan/MSFC via Flickr1. JPL presents a paper on a software framework used for planetary science that functions as ” a kind of search engine that allows scientists working with data in one expression or format to find and compare their data with another.”
2. National Cancer Institute representatives involved with the Early Detection Research Network see the presentation, understand the framework’s potential and hire JPL to consult.
3. The project evolves and CHLA’s Virtual Pediatric Intenstive Care Unit joins the effort to “build a distributed data-sharing network to drive the next generation of clinical decision support for pediatric cancer treatment and research.”
Here’s Ahier’s explanation of why the NASA system makes a difference for the hospital:
The VPICU connects emergency rooms, community hospitals and intensive care units worldwide in a virtual network, extending consultations to even the most remote areas. Using (the JPL technology), clinicians can access data from a network of pediatric hospitals to build an evidence-based foundation for research into childhood cancers.
“The variability in patients in a pediatric ICU is enormous with regards to age, weight and other factors,” says David Kale, a research engineer in the VPICU. “So the question is can we build clinical decision support tools that will help clinicians by augmenting their experience by providing data.”
Hospital’s struggle illustrates health IT woes
Filed under: Health data, Hospitals, Hot Health Headline
The University of California San Francisco Medical Center has written off more than a third of the $50 million it has spent on a system to digitize patients’ medical records, according to an article by AHCJ member Fred Schulte for the Huffington Post Investigative Fund and American University’s Investigative Reporting Workshop.
The hospital started the project more than five years ago but after “persistent technical headaches,” it is has terminated the contractor and will start over on part of the project.
The costly setback pointedly illustrates the challenges health professionals face trying to meet a government mandate to bring American medicine into the computer age.
Doctors and technology analysts are less than enthusiastic about products now available. “Early reports from some American and European hospitals, they say, suggest that some technology may prove unreliable and could even pose safety problems for patients.”
While critics are concerned about patient safetly, U.S. manufacturers say no injuries or deaths can be attributed to software failure. However, as Schulte points out, “companies manufacturing health information technology systems are under no obligation to report injuries resulting from software malfunctions to the government.”
Schulte then cites a number of examples that point to failures or problems with software systems.
Related
Survey reveals how much patient privacy is at risk
Fred Schulte and Emma Schwartz of the Huffington Post Investigative Fund report on a survey in which 75 percent of health organization say patients’ medical records were put at “risk of improper disclosure.”
The study, done for the Healthcare Information and Management Systems Society, also revealed that half of the people surveyed said they had “no plan in place to respond to security threats and many of them indicated that they are spending ‘little additional resources’ to combat the problem.”
While the federal stimulus package includes provisions to enhance the security and privacy of medical information, the survey found that many hospitals do not have and do not use tools to encrypt the data when it is stored or when it is sent over the Internet.
Schulte discussed the report on NPR’s Weekend Edition. The survey also was the subject of an iHealthBeat special report, featuring a health information technology officer, a representative of the Healthcare Information and Management Systems Society, the HHS deputy director of health information privacy and a patient advocate.
The full report is available from ID Experts but does require free registration.
Doctors face obstacles in transition to costly EMRs
Filed under: Government, Health care reform, Hot Health Headline
In his American Journey blog, the Wall Street Journal’s Andy Jordan considered the impact of stimulus funds on the health-care system’s expensive and time-consuming transition to electronic medical records in terms of physicians he encountered in his cross-country travels.
In rural Alabama, Dr. Regina Benjamin switched to EMRs after losing paper records to a combination of hurricanes and fires.
“When a patient or pharmacy calls at night or on a weekend, I do not have to rely on memory. I can access the chart from any computer, at home, from the hospital, from my hotel room when traveling.
This prevents errors and I can give better care. I can also quickly look at trends and patterns, pick up things earlier than if I had to look thru paper charts.” She was able to fund her conversion through donations and foundation support.
In Cambridge, Ohio Jordan met Dr. Patrick Goggin, who he said spent about $300,000 to convert to electronic medical records five years ago. Jordan recorded a four-and-a-half minute video showing the Dr. Goggin’s system in action. Jordan also spoke with Dr. Goggin’s colleague, Dr. David Ray.
“Advantages are not quite there as far as outweighing the costs,” (Dr. Ray) says.
“The technology is probably just not quite there yet for most solo practitioners and small practices to implement such a system.”
In the Minneapolis Star-Tribune Kate Levinson reports on growing demand for centers to store this medical data and on a study that found mid-size Midwestern cities to be among the most attractive to the medical data storage industry.
Steve Lohr of The New York Times reports that the obstacles to a transition to electronic medical records are daunting. Experts say that how local organizations help doctors in small offices adopt electronic records will be crucial to success. Lohr explains “regional health I.T. extension centers,” called for in Obama’s budget proposal that has been submitted to Congress.
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