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The news could not be sadder. Premature baby boy Genesis Burkett was given an IV dose of sodium chloride 60 times greater than the physician ordered. The fatal infusion has professionals and loved ones all around the situation looking to place blame. It’s only natural. It is the worst of human tragedies and people need answers. Sometimes answers contain a kernel of peace – sometimes.
In any case of error, medical or otherwise, there is usually some responsibility to go around, no matter how well intentioned or trained the people involved. I don’t know every detail and will try to refrain from passing any sort of judgment on a situation this sensitive to which I am not intimately privy. I do have, however, a few general thoughts on the issues as presented in the article. Those issues:
Some people are looking to blame the use of electronic patient records
An IV bag was allegedly mislabeled
A pharmacy tech input the dosage information into the pharmacy computer from a handwritten prescription
An automated alert system was not active when the information was entered
The initial interface with any electronic health record is the human who enters the data. Humans can only enter data they can accurately interpret or believe to be true. The hospital involved, Advocate Lutheran General Hospital in Park Ridge, Ill., apparently has reached the HIMSS Analytics Stage 6 of its health IT implementation, out of a possible 7, meaning it should have computerized physician order entry (CPOE) integrated into its system. In this particular case, it appears the relevant parts were not online and this prescription was outside that loop.
My gut reaction to this (and I’d like to hear yours, so please comment from your perspective) is that electronic health record systems are being asked to carry a lot of water when the bucket is still full of holes. A fully integrated and implemented health IT system, with well-trained staff and backup systems, may very well be positioned to avert tragedies such as these.
But we will never – and I use that term sparingly – be able to completely rely on any fully automated system in the care of human beings. The best health IT systems will accept, transfer, organize, analyze and process data that healthcare professionals enter. Electronic patient record systems will not have the capacity to look at the patient in front of them, determine that it is a frail infant that can fit in the palm of its father’s hand, and conclude that the dosage prescribed is far in excess of what is reasonable. Highly educated professionals, interacting with well integrated and fully implemented electronic health records, can deliver state-of-the-art care with the assistance of meticulously kept records and perfectly metered doses that match treatment protocols appropriate for the profile of the patient in front of them.
Medicine is yet an art as well as a science. And it is the most caring and skilled human beings, working in concert with finely tuned equipment, that will deliver quality care. In this imperfect world, under those conditions they will deliver it almost every time.
Question of the Day: Do You Really Need Fully Implemented and Integrated Electronic Patient Records?
Answer: Only If You Want To Get Paid.
As we continue to chew on the issue of what healthcare payers should pay for, the payees are starting to get a little nervous about survival under these rigorous conditions. Some have become creative in their approach to getting paid.
Personalized medicine: Instead of waiting for outcomes, providers using some biologics will know in advance if something works. Using genetic testing – at $200 to $5,000 a pop – providers will know if the drug under consideration will work in the patient in front of them. At the cost of genetic testing, the math only works if the drug in question costs at least 10 or 20 times as much as the test. But it is starting to be done, as labs are coming up with assays that can determine which genetic markers indicate susceptibility to a treatment. At this time, about 5% of employers are paying for this kind of advanced knowledge.*
Performance Rebates: Some drug companies give a money-back guarantee. In essence, they are saying, “Our drug works, we promise. Either the blood pressure numbers go down or you get money back.” This practice is not widespread, but one or two big players are trying it in some high-cost, high-utilization therapeutic areas to move product.
These are all steps along the road to paying for what works as the private sector tries to find gentler ways on this very rocky path. Because under health reform, payment is dependent on outcomes. Payers (ie, Medicare ACOs at first) will hold back a portion of provider payments in a “shared savings account” and will review measures with the “savings” to be “shared” as additional payments with the ACOs depending on their results.
How does this affect pharma, medical device companies, surgeons and anything or anyone else that gets measured in this process? Your product or service needs to have proven superior outcomes (trials and procedures that include lots of patients, lots of times) and have a value proposition that holds up under Comparative Effectiveness Research that tracks how well one drug, treatment, surgery fares against another in this cost/benefit scheme.
Not saying that this is necessarily a bad idea. In a perfect universe, it sounds like a reasonably fair way to apportion finite resources among the hundreds of millions of patients and their unlimited needs. But the 800 pound gorilla in the corner is collecting all this information in a uniform way that is usable, asking all the right questions in the right way and having a dispassionate third party crunching the numbers correctly. Then, depending on the results of the data analyses, buying the most cost-effective goods and services, and paying providers according to their patient outcomes.
If I’m selling drugs, I’ve got my fingers crossed that the data swings my way in those head-to-head comparisons. If I am a health network, I’m hoping I’ve had fewer readmissions than almost everyone else, so I’m on the better side of the bell curve when they distribute the “shared savings”.
To very roughly paraphrase one participant at that NYC confab on the future of pharmaceutical payments last week, he just wasn’t sure we had the ability to collect the information we need, or to know exactly what to collect, or how to collect it – yet.
When you get down to it, it’s all about the data. Only if you want to get paid.
*Pharmacy Benefit Management Institute, 2010-2011 Prescription Drug Benefit Cost and Plan Design Report.
Question of the Day: How Do You Know If You Are Paying For a Treatment That Works?
Answer: You Collect A Lot of Good Data.
Recently a tableful of health care big-thinkers gathered in New York City to cogitate on the future of the pharmaceutical industry. This happens all the time, all over the country – big thinkers thinking big things about healthcare around tables. The only thing different about this one is that I was invited to take notes and be a fly on the wall at this particular gathering, and the discussion triggered the thought that all of these conversations are starting to lead to the same place.
Bzzzzzzzzzzzz.
The issue on the table in New York was: What will payers pay for drugs? Will Medicare pay for a new drug? Will health plans pay? How will they decide what to pay for and how much to pay for it? These questions are couched in a single, larger question: What will payers pay for? The answer is in the data.
In the future, payers won’t pay for procedures and products. Payers (Medicare, Medicaid, health plans like Aetna, Cigna, etc.) will pay for outcomes. Did the patient get better? Prove it. We want to see the data. Lower cholesterol. ED use down. Shorter hospital stays. No hospital readmissions. Surgeries avoided. C’mon, show me the numbers.
Healthcare has been moving toward quality and outcomes measures for at least 20 years. But with health reform, we’re there. Health reform is bringing you Accountable Care Organizations (ACOs) as a mechanism to reimburse providers through the Medicare program. The model is expected to move out into the commercial payer universe after that. And ACOs don’t work without data to back them up.
ACOs require integrated provider environments – the hospital systems and networks that include acute and ambulatory care and the whole spectrum in between – to provide coordinated care to a patient so that actions can be tied to results. The twist is that providers, as members of networks and integrated systems, will be bound together under ACO agreements where they will be paid a bundled rate to provide care. Because of this payment scheme, any providers that have resisted the move to integration will be forced to merge into large networks that can afford to accept this risk. If you are looking at this through the eyes of the pharmaceutical industry, what do you see? You will be selling your drugs to fewer and fewer, larger and larger, customers. Probably for less and less money.
If you’re on the buying end of that deal, that sounds pretty good. But if you are on the selling end of that deal, you might wonder how long you can keep your doors open, or retain your expensive PhD researchers on staff. Just ask Pfizer.
As providers and product manufacturers stare over this cliff, the debate churns on about what to pay for. . .(to be continued).
Our host here at Healthcare Talent Transformation, Jonena Relth, has given me a platform for the past year and a half to talk about my passion – healthcare. We have chosen to restrict my conversations to the future of electronic patient records and its effect on the healthcare industry. Personally and professionally, I am in a season of reflection and change. That means that this will be my last blog here – at least for the foreseeable future within my line of sight.
Before I reflect on how far electronic patient records have come since I started guest blogging for TBD Consulting in July 2009, let me thank Jonena for this platform and opportunity to flesh out some thoughts on this topic. For those of you who know her, you know what an outstanding lady that she is. So, Jo, thank you. It’s an honor to be among the bloggers that inhabit this column.
Now, for the long view. As I look at the trajectory of health IT, the timing on this transition is perfect. My interest in the future of health information technology really dates back to 15 years in health policy, including several years doing research on the privacy of electronic patient records for the pharmaceutical industry after the passage of HIPAA and then research into the effects of a potential Y2K meltdown on the delivery of drugs to patients. Around that same time, I briefly worked for Intel to summarize the analysis of some workflow issues in the very early days of dissecting physician productivity as it is affected by technology.
In the context of HIPAA and Y2K, I had the great fortune of working for consultants to the top of the industry, looking at the critical importance of IT and how gathering accurate patient data would make healthcare better, cheaper, and more efficient. From my perch, most of the relevant discussions around these issues began in the mid-1990’s. It was just a matter of time until healthcare on the ground and at the bedside caught up to the academics and think tanks. We’re there.
Since President Bush appointed a health IT czar in 2006, the push has been on in earnest to move the discussions and plans out into the real world. And since the passage of the stimulus bill in April 2009, the momentum has been flash forward. Even since I began guest blogging in this space, much of what’s been pondered has come to pass. As a sign of the times, one of the most vocal and public critics of the health IT rollout plan for meaningful use, head of MGMA, Dr. William Jesse, is now on board and leading the push with our current health IT czar, Dr. David Blumenthal. And Blumenthal, perhaps as an indication that we have reached a new plateau in the uptake of electronic health records, announced that he’ll be heading back to Harvard to do what high-level ex-government officials do – continue to impart the values and agenda of DC decision makers to the nascent elite in that rarified Massachusetts air.
Let’s look at where we’ve been recently. In just the last 12 months, we have achieved certification of software, standardization of processes and coding, cross-discipline education pulling together IT professionals, medical professionals, and training experts, and the establishment of best practices for all aspects of development and deployment. It’s happening in a big way, and what used to seem like insurmountable hurdles are now just issues to be addressed.
One of the keys to success is that the federal government has managed to de-link electronic patient record laws and payments from health reform, so when health reform hits snags, it won’t trip up progress on health IT. As I’ve preached from this pulpit before, real savings, efficiency and quality will be the result of the benefits of electronic patient records, done well and thoroughly, with patient safety and clinical excellence as its guiding lights. Health reform involves politics (ie access) and payments, unlike health IT which involves quality and cost.
We’ve come so far, so fast, because so many have gone before and the dirt roads were already pioneered. The healthcare infrastructure of the future – the electronic patient record superhighway – is being built quickly and with only a few minor modifications to adjust to the realities of the road. A truly modern and efficient system is underway. Health IT has everything to do with good patient care, and it will rise or fall by respecting the privacy and individuality of the patients whose care is at the core of the mission.
The future track is inevitable because the cloud is the modern platform for information and communication, and the integration of technology into the fabric of human life naturally translates into the integration of technology into the fabric of the way we provide patient care. Recently, Jonena and I were talking about how health IT best integrates into provider settings, and agreed that electronic patient records will work best when they evolve out of the environment in which they occur – their greatest value will emerge organically when health IT vendors and users view information within the context of healthcare holistically. And that is why she is such a big fan of process mapping a project when she meets with a customer.
Technology in service to humanity; not humanity in service to technology. And all should be well. Again, thank you, Jonena, for allowing me to be part of your blogging family and thank you, dear readers, for your time. Please continue to reach out to me at peggy.salvatore@gmail.com. I expect to continue to work and write on my great passion in new ways. And to return to this space occasionally, as Jonena’s schedule and mine permit.
Always a pleasure. Onward!
Dear Readers,
We will miss the wisdom and insights of Peggy Salvator's blogs. She has been an integral part of our TBD blogging family and we hope her schedule will allow her to contribute her wit and knowledge on occasion. Please join me in thanking Peggy by staying in touch and following her career. She's an awesome lady with a passion for healthcare IT that is going to take her far! Jonena Relth
The last few posts have been dedicated to the job market because, well, the economy is on our minds. And still on the skids.
If the statistics are correct, one or two out of every ten people we know is looking for work. You might be on one side of the coin, just be hoping to get a family member off your couch. Or, you might be on the other side of the coin, looking to hire talent where healthcare and IT collide and finding that a lot of those skilled people are already otherwise professionally occupied.
A couple of things are happening when IT and healthcare collide. One is the aforementioned fact that those are two of the enduring categories of job growth so they will both remain competitive. No matter what else goes on in the world, the computer and the Internet are becoming ever more integral to our daily lives, and we all getting older, getting sicker and going to the doctor. The other fact that I just have to mention is that because IT in all its permutations is a fact of daily life and pervades everything we do now, that includes our political world. So when Wiki sprung a leak last week, it raised a lot of questions for those of us concerned about the privacy and security of patient data. Heck, if they can get information about high-level intelligence out of our defense IT network into the computers of every high school kid on the planet, makes you wonder how really safe our patient data will be.
So, when the larger IT and healthcare IT worlds collide, a few things happen. One is that whatever technological advances affect one are going to migrate to the other, and the second is that whatever forces affect the workforce of one will affect the other.
I’ve talked about patient privacy in this blog before, and I will again. The patients’ concerns about the security of their personal health information aren’t going away, and they shouldn’t. WikiLeaks brought attention to the vulnerability of even our most secure transmissions. As far as healthcare goes, it means we might want to drop back and re-evaluate our approach to patient data security. At the least, the healthcare industry needs some assurance from their IT vendors about why they aren’t exposed to the type of mass data dump that exposed our diplomatic and intelligence communities.
If anything, the WikiLeaks issue will cause an uptick in the need for a) reassurance for providers and patients and b) IT security specialists to build a better mousetrap.
One of the interesting takeaways from the slide show is that a few of the hottest tech skill jobs aren’t tech skills at all, but good management and organizational practices applied to the IT implementations– project management and change management. I also suspect that security specialists will become in even hotter demand as healthcare customers want to be assured their systems won’t fall prey to the kinds of shenanigans the US was exposed to last week.
Since I’ve been sharing some of the healthcare employment data in this blog lately, let me also revisit some new statistics that reinforce the fact that a good way to get your family off the couch is to check out the local hospital help wanted ads.
From HealthLeaders Media last week:
Online ads for healthcare practitioners and technical workers rose by 12,400 listings to 555,500 in November, the largest increase of any job sector for the second consecutive month, and vacancies for the skilled providers outnumber qualified job seekers by almost 3 to 1, a report shows
And from HealthLeaders Media this week:
While the nation's unemployment rate has increased to 9.8 percent, hospitals reported 8,000 payroll additions in November and 42,200 payroll additions so far this year. The growth in hospital jobs is nearly double the 21,700 jobs created in the first 11 months of 2009, but is still well off the pace of hospital job growth for most of the decade, data released Friday by the Bureau of Labor Statistics show. . . After erratic hospital job growth in the first seven months of this year, hospitals have seen four straight months of growing employment, and have added 23,900 jobs since August. Overall, hospitals employed more than 4.7 million people in November.
I’ve seen the employment graphs, things haven’t been this bleak in most of our lifetimes. But I also see the amount of work that has to be done to modernize our health system, and when we start to create the momentum to accomplish these tasks, we create work. It will be a slow, grinding awakening of our county’s economic gears, and healthcare and IT are some of the grease to help ease their movement back to life.
This is the third in a series of blogs on the worker shortage in healthcare and health IT. What is the health job market like in your area? Are you hiring or laying off? Drop us a response; we’d like to hear your thoughts on healthcare employment.
The other day my college daughter said she was thinking of changing her major to nursing from a soft science that had a high rate of graduating waitresses. I could only encourage her to make the switch. Ever since we started anticipating the aging of the baby boomers, we knew that the nursing shortage and even the spotty physician shortage in rural areas and certain specialties was going to get worse.
Ten years ago, I was looking at data that showed hundreds of thousands of vacancies in healthcare by 2020. And that was before the ruinous Medicare payment policies and other governmental permutations of the healthcare system that are seeing physicians stampeding for the exit. By the time providers and payers figure out what “Accountable Care Organization” means (one wag suggested ACO stood for “another consulting opportunity”), we will already be partway down the rabbit hole that has been dug by the passage of the Affordable Care Act.
Despite these invitations to confusion, day-to-day operations still occur. Patients show up for care in greater and greater numbers and healthcare professionals are there to provide it. As more patients show up for care in an increasingly sophisticated environment, there will still need to be receptionists, nurses, doctors and other healthcare professionals there to greet them, deliver care, and take their money – or insurance card, more accurately. And hospitals, doctors’ offices, labs and other ancillary service providers will need to be getting that patient data online and available to the rest of the system.
What I’m getting at (oh, finally!) is that we will continue to have more patients, we will continue to accelerate modernization of the system, and all this will happen with the financial and regulatory encouragement of the government who drives the bus. So while we may see reimbursements shift, and the type of healthcare professional who provides patient care change (fewer doctors, more physicians’ assistants and nurse practitioners), healthcare and health IT are growth areas.
More statistics:
By 2020, demand is set to outstrip supply in several specialties, with nonprimary care specialties in general projected to experience a shortage of 62,400 doctors. General surgery is predicted to be among the hardest hit, with a shortage of 21,400 surgeons. The number of practicing general surgeons is expected to fall to 30,800 by 2020 from 39,100 in 2000. Ophthalmology and orthopedic surgery are each expected to need more than 6,000 additional physicians over current levels. Urology, psychiatry, and radiology all are expected to see shortfalls of more than 4,000 physicians, according to the HRSA [Health Resources and Services Administration] figures.
A 2007 study conducted for the American Society of Clinical Oncology (ASCO) by the AAMC's Center for Workforce Studies found that demand for oncology services is expected to rise 48 percent between 2005 and 2020. During the same period, the supply of oncologist services is expected to grow only by 14 percent, translating to a shortage of between 2,550 and 4,080 oncologists.
Only 3.5 dermatologists currently are available for every 100,000 Americans. [A UCSF study showed] the shortage is caused largely by the cap on the number of residency training slots supported by Medicare funding; since 1970, the number of dermatology residencies has hovered at around 300 per year. According to AAD figures, as of September 2009, there were 9,179 practicing dermatologists in the United States. Patient wait times average about 34 days for new patients, and in some cases can run as long as three months.
Online ads for healthcare practitioners and technical workers rose by 26,800 listings to 543,100 in October, posting the largest increase of any job sector for the month, and breaking three consecutive months of declines. Vacancies continue to outnumber skilled healthcare job seekers by more than 2 to 1, a report shows. The Conference Board's Help Wanted Online Data Series, which tracks more than 1,000 online job boards across the United States, attributed the uptick to increases in advertised vacancies for registered nurses and occupational and physical therapists.
According to preliminary seasonally adjusted figures from the Bureau of Labor Statistics, healthcare has added more than 23,000 jobs each month since July, while the overall economy posted a net job loss in those months. On an annualized basis, healthcare grew by 239,300 jobs during the 12 months ended in October, or 1.8%. Hospitals in October added 5,100 jobs, or 0.1%, to a workforce of 4.7 million. Hospitals added 37,400 jobs in the 12 months ended last month, for annual growth of 0.8%. Physicians’ offices last month added 2,700 jobs, or 0.1%, to their workforce of 2.3 million. Doctors’ offices have grown about twice as fast as hospitals in the past 12 month, adding 41,900, or 1.8%, to a workforce of 2.3 million
One last story that flew in a few days ago said the nursing shortage has been abated by the economy which has forced older nurses to stay on the job past their planned retirement. The need is still there, but the positions aren’t opening up as regularly as they would have in a healthier economic time.
Another growing field will be patient data input, as newly automated patient record systems assimilate their old paper records online. I had lunch last week with an IT entrepreneur from India whose wife is a physician employed by the Veteran’s Administration. He has a data input business back home in India, and a consulting business here in the US. He has found that due to culture, language, privacy and security concerns and the technical nature of medical nomenclature, he is planning to build a US-based patient data input business and hire domestically. His experience echoed this story from The Wall Street Journal that detailed that healthcare data entry will be big business here and abroad.
When you overlay the needs of the patient care industry and the needs of the information technology industry on top of a struggling economy and its struggling participants, a picture emerges. The broad outlines are that:
There will be jobs in healthcare and IT
Some of those jobs will be in the area where those two fields overlap
Pay will be kept down in some fields where specialized knowledge and higher education are not required due to supply (a lot of unemployed people) and demand (people who don’t have a lot of skills and education).
Pay will be driven up in some fields where specialized knowledge and education are required due to supply (a finite number of people who have a lot of special skills and education) and demand (patient care experts and IT gurus).
Now, let’s gaze back down the Affordable Care Act rabbit hole. Due to the way the federal government is structuring reimbursement, due to insurance industry requirements, due to the number of medical school slots it funds, due to the requirements imposed on medical school applicants, due to the differing incentives for rural and urban practices, due to the differing incentives for Medicare and Medicaid participants, and just due to the fact that the government is trifling with the supply and demand parts of the equation using all these and many more tools, it appears there is a plan for some expected outcomes. Care for everybody, costs controlled, etc.
But, as we all know, the best laid plans. . .sometimes result in a trip to the Land of Unintended Consequences.
This is the second in a series of blogs on the worker shortage in healthcare and health IT. What is the health job market like in your area? Are you hiring or laying off? Drop us a response; we’d like to hear your thoughts on healthcare employment.
When your friends are out of work, it is a recession. When you are out of work, it is a depression. When you and your friends work in healthcare or information technology - or both – it’s boom times.
Check the headlines over the past few weeks, and you’ll find that healthcare at 17% of the US economy is still a functioning engine of growth. Yes, national unemployment hovers around 10%, and in some places better or worse (Utah about 4% and Nevada about 15%). But employment isn’t as much about geography as it is about your industry. In automobile manufacturing? Not so much. In nursing? Oh, yeah.
There is a shortage of healthcare workers from physicians down to the guy who switches out the bedpans. And there is a coming shortage in IT workers who are needed to transform healthcare from paper to electronic records.
Believe it or not, in places where people are practically bumming smokes because they are so broke, there are hospitals and employment agencies trying to find workers. Here’s a sample of the kind of issues we face to keep care coming to patients and to keep the system running smoothly as it transitions to electronic records:
• [A] survey by the College of Healthcare Information Management Executives (CHIME) found that more than 60% of hospital IT executives believe tech staffing shortages, which some estimate to be a shortfall of 50,000 qualified IT professionals, will definitely or possibly affect their chances to achieve meaningful use. (HITECHWatch, October 29, 2010)
[T]he unemployment rate for tech professionals (4.3 percent) is far lower than the overall national average (9.6 percent) (CIO Insight, October 28, 2010)
Mount Sinai Medical Center in NYC sponsored a hiring event on November 5 to “audition” people for 90 temporary technology training positions internally to help with their IT implementation (Healthcare IT News, October 28, 2010)
According to statistics from the federal Health Resources and Services Administration (HRSA), by 2020, demand is set to outstrip supply in several specialties, with nonprimary care specialties in general projected to experience a shortage of 62,400 doctors. (Association of American Medical Colleges website, https://www.aamc.org/newsroom/newsreleases/2010/150570/100930.html)
We are all in some way –either personally or people we know - touched by the serious economic downturn in the US. The causes are myriad and the solutions will not be simple or quick – it took a lot of missteps over a long period of time to dig a hole this deep. Recovery will be a long slog from here to economic health. In the meantime, a lot of people – families, businesses – have suffered losses and some may never return to where they were before the meltdown.
However, there are always pockets of growth in any economy and some places where it is good to be during a storm. Not everyone failed in the Great Depression. In fact, some fortunes were made by people with insight and tenacity. That is as true today as it was in the 1930s.
Healthcare and especially transforming the healthcare industry to a fully online and data-driven enterprise is a massive task. It will take an army of a million more workers to transform the army of more than 10 million currently employed in the healthcare sector. In this field we are in today, there is room for everybody. We need all the talents and resources we can muster to put together a rational system that works.
That means the need is great for systems designers, data and research gurus, dedicated providers, tenacious administrators and creative leaders all along the spectrum to move the entire industry into the future. The jobless rate in the US today is a sad statistic that belies the plight of many individuals; but there are jobs out there looking for workers and healthcare is one of the places to be today during this storm.
This is the first in a series of blogs on the worker shortage in healthcare and health IT. What is the health job market like in your area? Are you hiring or laying off? Drop us a response; we’d like to hear your thoughts on healthcare employment.
Online learning, e-learning, m-learning, asynchronous learning, web-based curriculum. What do you call it? What is it? And what might it have to contribute to transforming healthcare?
At an ASTD (American Society for Training and Development) Chapter board meeting last spring, we elected to start a special interest group to discuss elearning, and we grappled with finding an identity for what historically has been known as computer-based training. As it turned out, no matter what definitions we used, the concept generated a lot of enthusiasm from our own members and people outside our organization. To date, our elearning special interest group started just two months ago has met or broken attendance records for its first two online meetings.
Knowing our experience, I was a little surprised to see this link in the eLearning Insider Newsletter this week:
Is the LMS Dead?
My answer to that question is another question: Have We Even Started to Tap the Potential of the LMS?
More likely, online knowledge capture, transfer, and measurement for organizational improvement is in its infancy. Even bricks and mortar institutions are looking at their asynchronous classroom offerings and seeing their web-based future. This week, the Chronicle of Higher Education asked the survey question: What role does online learning play on your campus? And then posted this announcement:
"Due to an overwhelming response from our readers, the Online Learning Survey will remain open until Friday, October 29. Don't miss this opportunity to voice your opinions. Online, distance, and blended learning programs are playing a significant role in the way institutions deliver courses and are becoming a part of many institution’s strategic plans."
The move to web-based, asynchronous, online, mobile learning – partnered with social media platforms – means the way we relate education and information can be real-time, all the time. This has important implications for bringing nearly 20% of our economy online and all moving in the same direction. Healthcare (which yes, does account for almost 20% of our economy today) will need to bring millions of providers online in a unified and concerted way to extract the true value and benefit of electronic patient records.
We need face-to-face, boots on the ground teachers to translate some of the high-touch aspects of patient interactions to fully electronic patient records, but a lot of the education can be done in a consistent way, with rapid deployment at the point of service, using all the elearning modalities available to us today.
The LMS isn’t dead. It is one very important piece of a growing healthcare pie.
Peggy Salvatore writes training for the healthcare industry. She developed Health System Ed, a basic health IT training program to advance the uptake of electronic patient records. In addition to the basic e-learning program available online, Health System Ed can be customized for specific healthcare environments and software applications. To learn more about Health System Ed visit www.healthsystemed.com
It is exciting to be hosting Health Wonk Review this week. For the past few weeks, I’ve been thinking about finding a unifying theme for all our bloggers’ wide-ranging topics. With health reform celebrating its six-month anniversary, what other news could top that? My first thought was to go with that, but then... you won’t believe this, I found something that was even more headline-worthy than six months of health reform. Watch this video, then let’s talk...
You might be thinking, what does this have to do with healthcare? So was I, except this is so bizarre, it makes a great “hook” for this week. The UN has chosen a Malaysian astrophysicist, Mazlan Othman, as this planet’s ambassador for our first alien contact. You know, just in case. Which kind of puts that whole health insurance problem in perspective, if you think about it for a minute.
So, in the spirit of “take me to your leader,” let’s start with a blog entry by one of the founders of Health Wonk Review, Joe Paduda at Managed Care Matters. In this week’s entry, Patient confidentiality? Not in Texas, Joe details some unsavory goings-on in Texas, where former state Rep. Bill Zedler, R-Arlingon, after receiving $25,000 in campaign contributions from two doctors just weeks earlier, requested and was given access to their patient records for treatments that were under investigation by the state. Those "egregious" treatment violations included injecting jet fuel into patients in order to diagnose chemical sensitivities. Former state Rep. Zedler said he had the knowledge to examine the records based on his experience as a medical device salesman. This couldn’t get any worse. Patient confidentiality is violated here on two outrageous premises: 1. A (bribed?) state legislator had access to patient records in an attempt to scuttle an investigation into alleged patient injuries and 2. A medical device salesman had access to patient records. HIPAA, schmippa.
Which leads the untrained mind to wonder. . .what kind of fuel is used in alien spacecraft? Does it get a million miles to a gallon? And can it be injected into patients?
Let’s stay with our terrestrial leaders for a minute, and visit with Health Wonk Review’s dedicated administrator Julie Ferguson at Workers’ Comp Insider. In this week’s post, Julie reviews a guide on how to select the best docs for your workers compensation programs in Required Reading: How to Find the Best Docs. She described the guide saying its “stated purpose” is to “provide specific guidance and resources to all stakeholders. . .from injured workers and employers to insurers and TPAs.”
Before we spend time in the health policy universe, let’s spin even a little farther out into the multiverse and visit Tinker Ready and the Boston Blog. This week Tinker Ready is promoting something that is oh-so-promotionally worthy in Laugh then think: Sold-out Ig Nobels to be webcast live from Harvard Thursday, 9/30. The Ig Nobels are an annual awards ceremony that takes attendees on a comic romp through the world of academia and scientific research. Also included here because Tinker Ready chose to embed video in her blog, and besides, it’s fun. Unfortunately, the event is also sold out. So you’ll have to stay home and watch the webcast.
Back on terra firma, the real controversy in health reform is playing out in the health insurance market place. David Williams at Health Business Blog posts his discussion on Narrow networks make sense, but they won’t do much to hold down premiums. In this week’s entry, David holds a comprehensive yet succinct discussion about the interplay between choice and cost, something that has been playing out since the early days of HMOs, as he points out in his blog. In the final, he concludes that this is one more trend that is going to accelerate consolidation in healthcare.
Further moving the consolidation discussion along is Austin Frakt of The Incidental Economist who sent us a post on Competition on Access. Frakt, and his associate Rex Santerre, maintain that “due to low revenue and high debt, some government health care facilities are closing while others are being sold to private-sector firms. These developments may result in normal market competition that tends to drive inefficiencies from the system. But something important could be lost when public facilities disappear – access.” This is an excellent parsing of the issue of how the delicate balance of profit, non-profit and governmental providers in a market maintain a balance of cost and quality choices, and thereby increase access due to the range of competitors. Government has acted as a healthcare safety net for generations of indigent, and Frakt and Santerre explore one aspect of what happens when the safety net has holes.
Speaking of shredding the safety net, Jason Shafrin over at the Healthcare Economist asks the question Do Medicaid Managed Care Organizations Save Money? He cites several studies showing that managed care options within the ultimate patient safety net, Medicaid, have not saved state government money and that healthcare outcomes are poorer than their commercial counterparts. For those of us who have been watching Medicaid managed care fairly closely for nearly two decades, this is not surprising.
When I first arrived on this planet in the early ‘90s (that would be the health policy planet, of course), our consulting firm was hired to do a study of then-emerging managed care entities into Medicaid in all 50 states. Our conclusions at that time have pretty much played out in these subsequent studies cited in the Healthcare Economist. Since that time, the numbers of uninsured have climbed both in terms of raw numbers and as a percentage of the population.
Rich Elmore at HealthcareTechnologyNews shares the latest discouraging census bureau statistics on the uninsured in 50.7 Million Uninsured in 2009. The charts tell the story.
And Avik Roy over at The Apothecary tells us How Medicaid is Burying the Empire State. The New York State budget crisis is exacerbated by Medicaid spending, per capita worse than any other state in the union.
The state to watch, though, is Massachusetts. David Harlow at HealthBlawg reports on the next stage of health reform in the Bay State in Massachusetts Health Care Payment Plan Gets Renewed Attention: Global Payments to Replace Fee for Service. David tells us that MassHealth (Massachusetts Medicaid) will be one of the first in the water with bundled payments for episodes of care, which is the bedrock of ACO, possibly rolling out something by January 1. All eyes will be on this. Go over and check out David’s blog to learn the details.
And no discussion of publicly funded healthcare is complete without visiting the planet Medicare which orbits in the same solar system as Medicaid. Both revolve around the sun known as the Centers for Medicare and Medicaid Services.
The Colorado Health Insurance Insider blogger says some politically motivated individuals are telling fibs about health reform. Shame on them. In Very Few Real Estate Transactions Will Be Affected by the New Medicare Tax, we hear that the 3.8% real estate tax on sales of homes and other capital gains won’t affect most people because they don’t make enough money to pay into it. Which means don’t worry, the government isn’t really going to make much money on this. And that leads us to wonder – if this law really doesn’t affect most people and won’t really generate much revenue, what’s the point?
And it just might be the ideology that gets you, according to Jaan Sidorov at The Disease Management Care Blog. In his post Ideology vs. Values in Health Reform, Jaan Sidorov takes HHS Secretary Sebelius to task for what he describes as a governing style dominated by “toxic ideology.” She and others in the Administration just don’t get the difference between ideology and values, Jaan says. And then he muses, “No wonder the Tea Partiers are being so surprisingly successful, eh?”
Still circling the governmental health reform globe, we now land at InsureBlog. This week, InsureBlog’s Bob Vineyard sends us Obamacare Roll Out – Good or Bad? In this post, Bob ponders the age-old bromide that you can’t get something for nothing, so how is it that the gang in DC has managed to convince the voters that they can? To make his point, Bob takes a look at how Obamacare would work if applied to auto insurance. He makes you laugh, and he makes you wonder if there is any intelligent life on Earth at all, or at least in the august halls of the federal government.
John Goodman’s Health Policy Blog gets down into the detail of Obamacare in Paying for Health Reform. Specifically, John revisits the content of his Wall Street Journal editorial of the previous week that criticizes the nearly systematic dismantling of one of the few success stories in government-sponsored coverage, Medicare Advantage. Visit John’s blog and get the full picture. I can’t possibly do justice in a sentence or two to this debate that engages some of the leading lights in health policy.
The threats to patients aren’t all financial. Over at Healthcare Hacks, Fred Lee discusses how Diagnostic Errors Are A Threat to Patient Safety. Fred cites a British Medical Journal article that exposes the fact that sometimes a “working diagnosis” passes for a full and correct diagnosis, which can frequently lead to the wrong treatment. Fred encourages providers to do what you might imagine they are encouraged to do at most credible medical institutions, which is to make sure that the patient receives the correct tests and that a thoughtful analysis of the clinical and laboratory evidence should be undertaken to arrive at a correct diagnosis before initiating treatment. That brings another bromide to mind: haste makes waste – and in this case, the waste is human lives.
Those old sayings have stuck around for a reason, I guess. But what about the saying that when something is really terrific that it is “out of this world?” Wonder if we’ll find out sometime soon?
Now on to my favorite healthcare topic on Earth these days, health IT. For that, let’s go to a relative newcomer to the world of blogging, Michael Koriwchak, MD over at The Wired Practice. In this post, The ROI of EMR Explained, Michael tackles an issue we’d all love to know: will the investment in Health IT result in savings? Michael comes down on the side of the angels as he comes up with a unique approach to explaining why EMR is good for the medical practice bottom line. Like Bob Vineyard’s auto insurance analogy at InsureBlog this week, Michael also uses an analogy from the wonderful world of cars. It must have something to do with our American fascination with the automobile. Mike’s personal experience as a practicing clinician gives us great perspective on how the electronic medical record results in a more efficient practice and better patient care. He promises to continue blogging on the issue of ROI, so keep your antenna tuned for more from The Wired Practice.
And while we’re on the subject of wiring the clinical environment, Maggie Mahar weighs in at Health Beat Blog on some of the more intrusive aspects of technology in The Hospital Room of the Future, Brought to You by GE. Maggie says, “ ‘Smart Patient Rooms’ spy on nurses, doctors, and other health care workers to make sure that they are washing their hands. Over time, the technology will be expanded to check up on them in other ways.” Read about her concerns.
We have other bloggers who are less than enamored with some of the doings at large corporations. For example, Ray Poses, MD, at Health Care Renewal takes on J&J this week. In this entry, Should the President of Michigan University be Held Accountable for Johnson & Johnson’s Adulterated Drugs and Defective Devices, Health Care Renewal continues to pursue its mission as “addressing threats to health care’s core values, especially those resulting from concentration and abuse of power.” The bloggers at Health Care Renewal are also trying to come down on the side of the angels. In the true spirit of journalism, we’ll put the stories in front of you and let our readers draw their own conclusions. Read it and then, as our discriminating viewers always do, decide for yourself. Because there is, after all, some intelligent life on Earth.
And while we’re in the pharmaceutical neighborhood, let’s wander over to visit another regular to the blogosphere, Brad Wright at Wright on Health. This week, Brad looks at Free Medicine!, a take on patient assistance programs, or PAPs. In the interest of being “fair and balanced,” we present Brad’s much more favorable take on the pharmaceutical industry. He concludes that the PAPs work, and that pharmaceutical companies are doing their part to get life-saving medicines into the hands of patients who need them but can’t afford the huge price tags. Charitable works and good business frequently go hand-in-hand, and for some homosapiens it’s all about the milk of human kindness.
And finally, circling back around the health policy galaxy to my health IT home turf, for a good roundup on health IT news with a little bit of commentary thrown in, check out the HITECH Answers blog. This week the blog post on this site keeps readers informed on the House Panel Hearing on Meaningful Use. If you’ve been following the government’s push for electronic patient records, meaningful use is the 8,000 pound gorilla in the corner.
Thank you to Health Wonk Review for giving Healthcare Talent Transformation the opportunity to host this week. It’s been a lot of fun to reach out to the other bloggers and roam the healthcare universe with you. If you are of a certain vintage, you’ll understand when I say that health policy wonks don’t come from another planet, but sometimes we do colloquially “come from France.”
You might have people who accept the evolutionary change and stay, people who don’t and leave, or people who can’t and are eventually eliminated by some organizational variant of natural selection.
In moving from a paper-based to electronic medical records system, change may appear in either form in an organization. It may come in as a revolution and up-end the status quo, sweeping away the old way of business and bringing with it all new systems and processes. For most organizations, federal mandates are the change agent. Do it or don’t get paid (eventually).
Without government mandates, without a doubt, electronic medical records would eventually be integrated into the healthcare environment through a more gentle, evolutionary process. Simply, medical schools are graduating tech-savvy providers who are used to doing everything online. The nurses, doctors, pharmacists, staff and executives in healthcare organizations do everything better, faster and smarter with technology in other areas of their lives. Over time, healthcare providers will expect to take those technological advantages to work with them.
Because the change is being pushed from the top down, rather than being sought from the bottom up, it takes a little more organized effort from the training and human resources staff to pull through the technology. In a revolutionary change model, you’ve gotta prepare people for change and the new technology you are requiring; in the evolutionary change model, you just have to manage the naturally occurring change and supply the technology for people who are seeking it.
Most healthcare organizations are in a revolutionary, top-down mode for managing the change in their environments. Some organizations are in the evolutionary, bottom-up mode, but they are still fewer and farther between. [HIMSS EMR Adoption Model]
In another generation, the full integration of IT into the healthcare environment would be a natural and evolutionary process. And that might seem like a kinder, gentler approach. But you have to start somewhere, sometime, setting standards and goals, and putting the network in place to handle the integration. That calls for a revolution of sorts – change here, change now, and change according to a master plan. That’s where we are today.
By requiring providers to integrate health information technology into their work environments now, the federal government is pushing the revolution from the top down. What that means in terms of organizational development is that the change will require some hands-on management from the people responsible for pulling it off on the ground.
Evolution is nice, things change according to the natural flow of events within the context of their times. Revolution sometimes is necessary to move things firmly forward toward a defined vision in an organized way.
