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Friday, August 20, 2010

Fines Do Not Matter, Transparency Does

I don't normally write about patient safety or risk management issues directly, but the news in today's Boston Globe about a potential whistle-blower lawsuit by a fired Jordan Hospital nurse grabbed my attention. I actually think this story is as much or more about transparency than anything else. Fortunately, in this instance, it appears both mother and newborn twins (born premature) are doing well. I choose to believe this is due to a combination of factors including the talent and care provided by the receiving hospital staff (South Shore Hospital), the mother and her infants, and perhaps even grace.

The Infractions in question relate to a federal law that prohibits hospitals from transferring patients without first making sure they are stable and have been examined by a physician. The plaintiff has been a nurse at Jordan for 38 years, most recently as director of occupational health and risk management - so she is presumably intimately aware of federal and state laws attendant to transfers as well as reporting violations to proper authorities when they occur. Nurse O'Connor accuses Jordan Hospital of terminating her employment because she reported a violation of the aforementioned federal law.

What is most concerning about this alleged incident (now that mother and children have recovered) is the focus on fines (of the hospital) and punishment (of the hospital and the nurse, assuming it contributed to her termination) rather than on transparency. The protections afforded to whistle-blowers stand as an important example of the great strides the healthcare industry has made over the last decade toward the issue of transparency. Public reporting of healthcare costs, outcomes and quality improvement by providers (including hospital leadership, example Paul Levy's popular blog), payers (including CMS) and vendors (including WebMD) alike will continue contributing to this movement. An environment that celebrates and encourages transparency will ultimately have a far greater impact on quality and safety than fines and punishment.

Friday, August 6, 2010

How Do You Get 5,100 Cyclists to Ride 190 Miles & Raise $31M?

Give them free food and drink, of course! There are few topics as serious or important as cancer research and treatment - except maybe research and treatment of pediatric cancer. But the Pan-Mass Challenge is much more than just a hugely important fundraiser. For many, it's a vehicle to sacrifice in a comparatively small way and take part in something bigger than the individual. For these people, the ride is a way to jump in with both feet (or wheels) and try to make a difference for friends, family members or even themselves if they too are battling the disease.

Whatever your reasons for raising funds and putting in the miles, every rider will take away at least two things from this year's edition of the Pan-Mass Challenge:

  1. unbelievable memories from the stories, signs and shared spirit among fellow cyclists, volunteers, and survivors, and
  2. fee food and beer

Yes, due to the annual and very generous donations of sponsors like Cape Cod Potato Chips, Harpoon Brewery, Stop & Shop, Whole Foods, and many others, riders will enjoy some of the following goods over the 3-days of PMC:
  • 19,000 bananas
  • 14,000 bags of trail mix
  • 9,800 hamburgers
  • 7,000 Cliff bars
  • 6,800 slices of pizza
  • 5,500 hotdogs
  • 3,000 bagels
  • 3,000 lbs of chicken
  • 1,600 loaves of bread
  • 1,400 lbs. of pasta
  • 1,300 lbs. of peanut butter
  • 500 lbs. of sliced turkey
  • 500 lbs. of sliced ham
  • 275 watermelons
  • 160 kegs of beer

Thanks and cheers to ALL the sponsors and volunteers, all 3,000+ of you!

Thursday, August 5, 2010

The HEALTH in Health IT Junkie

While this blog is ostensibly about all things healthcare IT, I do have other interests in my life. One of those is cycling and another The Jimmy Fund. As it turns out, those two interests converge each year on the first weekend in August when I ride in the Pan-Mass Challenge. In its 30-year history, the PMC has raised over $270 million dollars for cancer research and treatment through The Jimmy Fund.

By this time each year I will have ridden my bike over 2,000 miles and raised over $4,500 in preparation for this annual ride. I will have sent out 400 emails, 40 letters and still more hand-delivered in neighborhood mailboxes (old school SPAM) requesting donations. Now all I have to do is ride my bike with over 5,000 of my closest friends across the state of Massachusetts in two days. In other words, now the fun (and rewarding) part begins.

You can donate to the cause by visiting the PMC website.

Monday, August 2, 2010

I Will Gladly Pay You Tuesday For A Hamburger Today

It will be three weeks ago tomorrow since CMS and ONC unveiled the Holy Grail of HCIT - the Meaningful Use Final Rule. Why have I waited so long to write about it? Hey, one must savor 864 pages of government-speak every now and again (not counting the comparatively wimpish 228 pages of Standards and Certification Final Rule). True it takes time to go through these with a fine-tooth comb, but one can fairly readily identify the most talked-about pieces of the Final Rule - namely those that tell hospitals and eligible providers what they must do to earn the money. But there have been countless blogs and articles describing the Final Rule - they've largely done a fine job with that, and you don't need yet another one here. I'd rather write about what I think the Final Rule means for HCIT adoption. At least two things stand out to me:

First, there STILL remains a fair amount of important detail left to the imagination, particularly about CPOE, that makes it difficult to predict exactly what it means for HCIT adoption. The Fed clearly lowered the bar across the board by including the Emergency Department and decreasing thresholds for many objectives. But for some objectives (again, CPOE) it's not exactly clear what the impact will be. CPOE has been made easier (for hospitals AND vendors IMO) by limiting it to medication orders, including the ED and decreasing the threshold to 30% of patients with a medication order. But ONC has created confusion over the issue of who must enter these orders (I mean really enter them). Ironically (perhaps only to me), the Proposed Rule listed RNs by name as being able to potentially enter orders, yet it's the "by any licensed healthcare professional" in the Final Rule that has everyone scrambling to define whether and which non-physicians must enter orders. Furthermore, by only requiring that ONE medication be entered electronically, has ONC potentially introduced more workflows for providers to navigate - a "compliant workflow" for electronic meds and a "non-compliant" one for paper med orders? That's not an improvement for efficiency and will only stall physician adoption of CPOE.

Secondly, by introducing the concept of Core and Menu Set Objectives (expected) AND changing so many of the thresholds (expected for some) AND limiting CPOE to medication orders (curve ball) AND bringing the Emergency Department into play (never doubt the power of a good lobby), it's hard to get a read on what all this really means. And that brings me to this blog post's mascot - Wimpy. No, I'm not calling the Fed a bunch of wimps - or providers or hospitals for that matter. I will not discount the fact that they still face a daunting challenge to implement, integrate and most importantly use technology that has largely done a poor job at all three.

No, I chose Wimpy because of his famous saying "I will gladly pay you Tuesday for a hamburger today". Am I saying that the government has created requirements for hospitals and providers for which they will not pay incentives in the future? Some fear just that, but it's not my point in citing the wise Wimpy. In fact, I'm kind of saying the opposite - we'll have to wait and see if by giving hospitals and providers a hamburger today whether they will pay us all back (it is the taxpayer's money after all) with use of systems that will achieve the 5 broad Health Outcome Policy Priorities (remember those?) defined by the Fed way back in February of 2009 when the HITECH Act was created.

So what do I really think? I think the government has provided short-term relief for a long-term challenge. If the lowering of the bar in Stage 1 causes hospitals and providers to just go after Stage 1 incentives and then stop then HITECH will have been a failure. If lowering the bar causes hospitals and providers to lose focus on the longer-term challenge of Stage 2 and beyond, then HITECH will have been a failure. Will it have created jobs in the vendor market? Will it have created a lot of investment and interest in HCIT? Yes to both. But neither of these will satisfy the Health Outcome Policy Priorities of:
  1. Improve quality, safety, efficiency, and reduce health disparities
  2. Engage patients and families
  3. Improve care coordination
  4. Improve population and public health
  5. Ensure adequate privacy and security protections for personal health information
Wimpy, pay up!