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April 4-8, 2009 | Chicago, IL
The HIMSS09 Annual Conference & Exhibition showcases cutting-edge thinking in health care information technology. Follow blogs from H&HN Senior Editors Matthew Weinstock and Suzanna Hoppszallern and Staff Writer Haydn Bush for daily updates from the meeting. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
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Are you just putting in time?
by Matthew Weinstock @ 3:15PM
It’s the closing session at HIMSS09: Everyone is worn out after four days walking the enormous exhibit hall, sitting in dark, overly air-conditioned meeting rooms watching PowerPoint presentations, and endlessly schmoozing and getting schmoozed.
So the closing session is usually one that allows you take pause from the week’s events. But Capt. Jerry Linenger, M.D., wasn’t about to let the remaining attendees simply limp off to the airport. No way. Not after what he’d been through.
Linenger is a doc—and a Navy pilot and astronaut, as well. He spent five months on the Russian space station Mir. His storytelling was captivating, letting listeners vicariously live his experiences: “3Gs, can barely breath. 3Gs, a crushing release…the body becomes weightless…you see Cape Cod, Chicago, London…you’re in space.”
Linenger was on Mir with two Russian cosmonauts, neither of whom spoke English. His Russian was bad, at best. But his biggest surprise wasn’t seeing the Earth at a distance, or the stars up close, or walking in space. The biggest surprise was that they all got along. “We had a common purpose, a common cause,” he said.
Linenger told several colorful stories about crisis after crisis that took place during those five months, including a fire that nearly turned fatal. But his overarching theme was to make sure you aren’t just “putting in time.” If you have a passion for something, nothing can stop you, he says.
That’s a lesson many in the audience and in health care can understand.
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Wait 'til next year on stimulus promises
by Haydn Bush @ 2:00PM
On the final morning of HIMSS09, the crowd at McCormick Place was thinning as attendees, dressed more casually than earlier in the week, toted luggage to their sessions and the exhibit hall.
The big themes of this year’s show were interoperability and the $19 billion in health IT spending promised by the stimulus package, and many of the booths touted stimulus calculators or referenced the American Recovery and Reinvestment Act in their signage. Still, everyone from vendors to attendees to HIMSS speakers noted that it’s too early to tell what rules and standards will emerge for IT adoption, and which products will stand out as a result.
Looking forward to HIMSS10 in Atlanta, the hope is that the Obama administration will have clearly defined what hospitals need to do by next spring, and that HIMSS exhibitors will have better pitches than simply promising hospitals a chunk of the $19 billion if they purchase their products. Not to mention that another year of “it’s too early to tell” will cause significant anxiety among hospital IT departments.
I also saw quite a few vendors touting recovery audit contractor products or calculators. With the national version of this CMS program getting underway—which broadly seeks to recoup Medicare overpayments due to coding errors or, controversially, medical necessity denials—I suspect momentum for RAC products in this arena will grow exponentially by HIMSS10. Most vendors are offering a two-pronged solution that includes proactive support for appealing claims denials alongside an internal piece that analyzes billing and coding workflows and adds some system oversight to the medical necessity review process. As with RAC in general, the sticky part for hospitals will be in identifying a system that tackles the tough medical necessity issues—thus avoiding costly denials and revenue losses—without alienating clinicians.
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Taking the guesswork out of nurse staffing
By Suzanna Hoppszallern @ 1:30PM
A number of states are legislating nurse to patient ratios, but these laws don’t address staffing needs for patient acuity. In a Tuesday afternoon session, Carol Watson, R.N. described the journey Mercy Medical Center in Cedar Rapids, Iowa, took to develop an automated evidence-based patient classification system in response to nurse and nurse manager concerns that staffing reports were not timely and took too much time to maintain.
About one-third of hospitals have a patient classification system; most are homegrown and don’t interface with online nurse documentation, according to Watson, professor-clinical at The University of Iowa College of Nursing. But the latest generation of automated patient classification systems can match in real-time a caregiver’s skill profile to current and upcoming nursing shifts.
“The power of the patient classification system is that it helps the hospital look at changing patient acuity and needs over time based on the category of needs,” Watson said. Mercy Medical Center’s goal was to consistently factor patient acuity to ensure workload equity, and the system had to integrate with the hospital’s existing staffing and scheduling and documentation systems. Nurse documentation in the EMR already flows into the patient classification system, and Watson said the nurses at Mercy Medical Center were candid about their workload: “Don’t add another task to our plate.” The automated patient classification system integrates with the staffing and scheduling system so that there is no need to re-enter data, and staff requirements are calculated automatically. Then, nurse managers can compare the nurses scheduled to those required and reallocate staff as needed, Watson said. After vetting the vendors and seeing other systems in action, Watson’s team concluded that it’s easier to integrate a patient classification system when it’s from the same vendor as the staffing and scheduling system.
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Patients on their own and happy about it
By Suzanna Hoppszallern @ 1:00PM
Don’t take this personally, but many patients are perfectly content not talking to your staff. In a Monday morning session, Jeffrey Nieman and Ronald Kelley Jr. explained how self-service registration kiosks can improve the hospital’s revenue cycle and minimize bad debt without turning patients off. Nieman, patient financial services, national operations, and Kelley, senior director, revenue assurance, patient financial services, both of Conifer Health Solutions (a spinoff of Tenet Healthcare Corp., Dallas) spoke about implementing kiosks at Tenet to address cumbersome registration processes and wait times in hospitals competing with freestanding clinics and imaging centers. They said that patients typically have to fill out five to nine forms at registration for outpatient services. But when using a combination of kiosks and e-signature, most patients are registered in less than 3 minutes and can self-scan their insurance card and driver’s license and pay a co-pay. Neiman and Kelley said 97.3 percent of patients were able to register successfully using Tenet’s kiosks, and of those, 98.4 percent were satisfied with the process.
The machines are interfaced with the patient accounting system, Neiman and Kelley said, and use robust authentication protocols to accommodate potential mix-ups like patients who register with a married name. Additionally, a staff person monitors the patient users so the suspected misuse of identification can be addressed.
Tenet’s kiosks from NEC cost around $150,000 per system, but the health care organization calculated several million dollars in savings per year by eliminating paper, Nieman and Kelley said.
Nieman and Kelley offered several lessons from Tenet’s kiosk rollout. First, registration and patient-flow policies and procedures need to be standardized, and centralized pre-service financial counseling is a necessary support function. Registration staff members need to develop a contingency plan for managing technical or other problems. Both waiting area traffic flow and privacy should be considered when locating the kiosks. Before implementation, work with on-site staff to generate buy-in and to familiarize them with the machines’ functionality. Finally, appoint a “kiosk czar” to report on patient usage and problems.
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The little clinic that could
by Matthew Weinstock @ 11:00AM
Anne Marie Mulle opened her HIMSS09 session this morning with a close-up picture of two red chairs.
“These are our waiting room chairs. They are from the convention center. They are a constant reminder to us of what we are doing and why we are doing it,” she says.
The convention center, as in the New Orleans Morial Convention Center, which housed thousands of displaced residents after Hurricane Katrina struck. Mulle is a family nurse practitioner at Common Ground Health Clinic, a free clinic serving Algiers, New Orleans’ 15th Ward.
“Nine days after Katrina, volunteers started going around the community knocking on doors and seeing if people needed help,” she says. That group of volunteer clinicians quickly opened Common Ground Health Clinic in space donated by a local mosque. The clinic initially was open every day, averaging 100 patients each day. Most of those patients had been using hospital EDs as their primary source of care.
Mulle was one of the volunteers. She graduated from nursing school in San Francisco in 2005 and planned to go to New Orleans for just two weeks to help out. But she got swept up in a “life-changing experience.”
Mulle’s presentation was refreshing, and not just because it was one of the few events I attended this week at which the stimulus package wasn’t mentioned once—not once! Her story was one of the best-told tales about how health information technology, when done right, can change lives.
With help from the HIMSS Katrina Phoenix Project, Common Ground renovated its building (it had moved across the street from the mosque after four months) and deployed an EMR donated by Allscripts. Mulle spent six hours a day for three days training on the system, which went live on Valentine’s Day 2008. She said the first five weeks were rough, but the EMR is now an invaluable tool and every Common Ground patient has an electronic medical record. Many of the clinic’s patients have chronic conditions—hypertension, diabetes, high cholesterol; the EMR’s monthly patient reports track those whose conditions match certain clinical markers and who need a phone call to check if they are following care plans. The clinic is an integrated practice, so even the herbs prescribed by an herbalist are recorded and checked against medications the patient is taking. Social workers’ notes are documented as well.
All clinicians use e-prescribing, which Mulle says shaves valuable minutes off administrative work. Many of the orders are repeat prescriptions, and the system lets her fill out all of the fields once, “and then it’s just a click.”
David Collins, HIS director at HIMSS, who manages the society’s Davies Award program, said Common Ground is “doing things that are equivalent to” most Davies Award winners.
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Greenspan: Health care spending unsustainable
by Haydn Bush @ 10:00AM
Alan Greenspan, former chair of the Federal Reserve Board, said in Wednesday’s HIMSS09 keynote that he sees some signs of a slow economic recovery, such as declines in major manufacturers’ inventory. But he added that a quick turnaround is unlikely, arguing that the impending baby boom exodus to retirement will form a huge stumbling block to sizable economic growth. That demographic shift will also mean greater health care expenditures, and Greenspan argued that the share of GDP linked to health care—which he pegged at 16 percent—cannot increase indefinitely. Eventually, pressure will grow to limit expenditures, he said. “The necessity of confronting medical care versus other goods in society is going to start to rise,” Greenspan said.
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April 9, 2009 - Greenspan may be right. I have been in health care imaging services since the inception of Medicare. Then, a chest x-ray cost $5.00 including interpretation. Now it’s $350.00 plus $125 for interpretation. Repair costs for a CT scanner are now a minimum of $425 an hour, 2-hour minimum, plus 2-hour travel, same rate $1700.00 without parts. - Thomas King, director ancillary services, Community Hospital of Long Beach April 8, 2009 - Why anybody would pay any attention to Mr. Greenspan is beyond me. Hopefully nobody paid that jerk a speaking fee. He is pure voodoo economics, period. And the architect of financial disaster for the last 15 years. His odds are no better than gambling and his advice is worthless. - Michael Carley, Las Vegas |
It slices, it dices, it can get you $19 billion
by Matthew Weinstock @ 1:30PM
It’s day three of HIMSS09, and I fully expect to see legendary infomercial salesman Ron Popeil somewhere on the exhibit hall floor before the show closes tomorrow. And if he’s not here, why not?
There are 905 companies at McCormick Place showing off their wares. I haven’t done a scientific analysis, but my best guess is that at least 900 of them are saying that they can help hospitals get their share of stimulus money.
Beyond attending educational sessions, H&HN reporters and editors spend a fair amount of time visiting vendors to learn about their latest products. In a normal year, the challenge is separating the wheat from the chaff—which EMR vendor really stands out from the others, which revenue-cycle product will help hospitals the most—and finding the new “hot” technology. Which exhibitor is this year’s Vocera?
But this is anything but a normal year. A great number of vendors I’ve met with suggest (some more strongly than others) that their product will propel hospitals down that “meaningful use” highway. Of course, none of us know what “meaningful use” means.
I spoke with Pam Arlotto, president and CEO of Maestro Strategies and former HIMSS president, on the exhibit floor, and she said that hospital leaders shouldn’t let vendors dictate what meaningful use is. Rather, hospitals need to come up with their own definition. “Are vendor solutions meeting your needs?” she asked.
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A smile for a mile
by Haydn Bush @ 10:00AM
After two days of HIMSS seminars that, regardless of the stated topic, eventually turned into critiques of either the federal stimulus package or interoperability, I needed something different. This morning, I ended up in a session on the emerging world of biofeedback devices. I wasn’t sure what biofeedback was going to mean in this context, but I was reasonably sure it wouldn’t lead back to ARRA.
Speaker Martin Hans Fuchs, the managing director of the Swiss firm InterComponentWare, gave an engaging talk about new activity sensors that go beyond step-counting to measure walking, running and inactivity.
Basically, the ActiSmile device gives users one of three “smiles” every afternoon depending on how physically active they’ve been. With a target goal of 30 minutes of moderate activity a day, the device gives a small smile for 50 percent of the target, a slightly broader smile for users who hit 75 percent of the goal and a full smile for those who reach 100 percent.
The cost of the devices isn’t high, ranging from $20 on the low end to $100 for more sophisticated versions.
Fuch’s company, in partnership with the Swiss government, tested ActiSmile recently on children who had health risks associated with inactivity. The key to the success of the program, Fuchs said, lies in the simplicity of the smile. “The device must be easy,” Fuchs said. “When you stand up in the afternoon, it smiles if you have enough activity.”
Fuchs said similar devices have been tested on adults and said the best results come when these tools are used in tandem with regular exercise coaching.
Of all the sessions I’ve attended at HIMSS so far, Fuchs’ talk got the biggest applause at the end, suggesting that this may be a disease prevention/wellness initiative that has some legs. One audience member, an executive from Blue Cross Blue Shield, got up after the presentation and told Fuchs, “You’ve made my trip worthwhile.”
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George Clooney has what?
by Matthew Weinstock @ 9:30AM
They are headlines that no hospital CEO wants to see: “Exposed: Clooney’s Medical Records,” “UCLA Staffer Looked Through Farrah Fawcett’s Medical Record,” and most recently, “Kaiser Cans 15 for Peeking at Octuplet Mom’s Medical Records.”
Security breaches don’t just cause bad PR and erode public trust, they can threaten a hospital’s entire business model. The problem, noted Kurt Johnson, is exacerbated by the proliferation of data and access points—PDAs, laptops, cell phones and thumb drives. Johnson, vice president of strategy and corporate development of Courion, a technology company focused on data security, told HIMSS09 attendees at an early morning session that hospitals need to do a much better job of defining who needs access to which information and which parts of the building.
Alegent Health, Omaha, Neb., has been on a three-year journey to retool its data security policies and procedures. Historically, the hospital did a poor job of limiting and granting access, said Troy Hottovy, Alegent’s operations leader of technical management. It used to take new hires, including nurses, up to three days to gain access to some clinical systems. The health care system relied on managers to tell HR and IT who needed access to what.
That system doesn’t exist any more. Alegent moved to a role-based system in which jobs are classified by position—nurse, physician, lab tech—then broken out into “sub-roles” such as emergency department. Your role determines the access you get. Things can be customized a bit, but managers need to approve any additional access. It hasn’t been a small task, Hottovy says, because Alegent has 1,400 job codes. The key, he notes, is to focus on what people are actually doing in their jobs.
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Less may be more at HIMSS09
by Haydn Bush @ 9:00AM
I chatted on the exhibit floor Monday afternoon with an executive from a clinical decision support company. Fewer people were visiting the booth than in years past, he said, but those who stopped by were more likely to be from the health care C-suite. In other words, the vendor exec said, organizations were sending fewer people to HIMSS, but those who got the OK to go were likely to be decision-makers.
It’s just one person’s theory, and the proof will be in whether vendors detect an uptick in sales following HIMSS. But it’s an interesting observation that’s backed up partially by the slight decrease in attendance. It would make sense that if one person from an organization is heading to HIMSS—especially amid all the excited stimulus talk—it would be someone who has the authority to guide the purchasing process.
The booths getting the biggest crowds are those with live shows, which are invariably about interoperability, EMRs or the stimulus package. After sitting in on a few presentations and looking at listeners’ name badges, I realized that many of these booths are subtly packed with representatives from the presenting company, creating a visual effect that draws other wanderers in long enough for a sales pitch.
Amid the high-tech atmosphere of HIMSS—where everyone is pitching the latest and greatest tool that will revolutionize your hospital’s care, make physicians happy and improve your bottom line—it’s oddly reassuring that centuries-old, low-tech crowd-building tactics used by carnivals still work.
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Should the Wii replace the water cooler?
by Haydn Bush @ 2:30PM
Self-described “e-futurist” Douglas Goldstein came home recently to find his two sons sweating after playing a simulated boxing match on the Nintendo Wii. His sons, who are 8 and 10 years old, are active in youth sports, so the idea they would be wiped out after playing video games piqued his curiosity.
Video games may not be everyone’s idea of healthy living—especially for kids—but Goldstein argued during an afternoon HIMSS09 session aptly titled “Health 2020” that the games, if used properly, can improve both physical and mental outcomes.
He noted that more than 600 “healthy video games” designed to encourage healthful behavior exist or are in production. Those offerings include the Re-Mission game for young cancer patients, in which gamers kill cancerous cells.
“In clinical trials, kids who play the game are more empowered and more likely to adhere to treatment protocols,” Goldstein said. Another game, Escape from Diab, is designed to teach children afflicted with diabetes about the disease.
Many hospitals already use these games or similar ones with their pediatric patients, and it’s encouraging that there is some research suggesting the games can create some real-world health benefits. Intermountain Healthcare, Salt Lake City, for example, has a suite of games on its Web site that promote active living and healthy eating.
But in Goldstein’s vision, hospital employees can also stand to benefit from the cognitive workout he believes a well-designed video game offers, along with the physical benefits Wii has helped bring to the industry.
Futurist that he is, Goldstein took these hypotheses and suggested that maybe providers should be setting up Wii competitions in the spirit of improving health care employees’ cognitive and physical performance—and possibly driving quality and safety improvements.
It may be a stretch to imagine that Wii games in the break room will increase productivity instead of hampering it, but at the very least, morale would improve. Unless one of those simulated boxing matches got out of hand.
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Is your EMR usage "meaningful?"
by Matthew Weinstock @ 2:00PM
It’s interesting to watch the rollercoaster of emotions the health IT community is exhibiting over the American Recovery and Reinvestment Act of 2009. Everyone at HIMSS09 is giddy about and eager to get their share of the $19 billion the feds will be doling out for health IT. And vendors are pitching services that claim they can ensure hospitals are “shovel ready.”
Then comes the realization that no one knows what the government will actually deem worthy of a slice of the pie. The ARRA says that providers must show “meaningful use” of an electronic health record. But when asked yesterday in an education session to define the term, even Rep. Tim Murphy (R-Pa.) said, “I have no idea.” Then there’s the issue of certification. Which organization will do it? What will be required? And there are a host of new security measures in the law as well.
All of this uncertainty could lead providers at the early stages of EMR deployment to pause and wait for regulators to work out the details. That’s not something Sunny Sanyal, chief operating officer of McKesson Provider Technologies, recommends. At a luncheon today, he said delaying implementation will put a hospital too far behind the rest of the field.
Still, even CIOs whose hospitals are far along on the deployment curve, like Denni McColm, CIO of Citizens Memorial Healthcare, Bolivar, Mo., expect that they may have to tweak their system once the regulations are finalized.
And, of course, everyone here has an opinion on what “meaningful use” should mean—information sharing among providers, a focus on quality indicators, documentation and clinical decision support. But the only opinions that matter are those of regulators in Washington, D.C. And until they set some parameters, the health IT community will just be playing a guessing game.
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April 10, 2009 - In one of the sessions, I heard that the best way to address the question of “meaningful use” is to transfer the risk to your vendor. In other words, make sure there is a clause in your contract when you buy a new system or major upgrade that says: The supplier warrants the system will meet the definition of “meaningful use” as determined under the ARRA federal program. How do the vendors feel about that? Will they do it? If not, why should we spend the big bucks now and maybe get burned later? —Frank Poggio April 7, 2009 - If you want to make the EMR meaningful, VHA’s Mike Cummins says you should ensure it links with all business information platforms in the hospital. Click here to read his post. —Lynn Gentry April 6, 2009 - Provider organizations can assist Congress by taking the initiative in defining meaningful use. This could be accomplished by listing the key variables that should be the basis for the selection of EMR software. For years hospitals, as part of a good strategic planning and a sound RFP process, have required vendors to show that their EMR software not only improved ways of entering, storing and reporting on patient information but actually could result in improved patient care. If an institution can then show Congress that its use of application software, Internet connectivity and reliable hardware as well as effective use of telemedicine technologies in fact lead to measurably shorter patient stays, fewer medication errors and higher rates of recovery, then Congress can react with clearer definitions of meaningful use as a basis for stimulus funding. —Abe Vorensky, health care IT professional |
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Where's the recession? Not at HIMSS
by Haydn Bush @ 12:30PM
Despite a sputtering global economy, nearly 25,700 have descended on Chicago’s McCormick Place for HIMSS09. That’s down 5 percent to 7 percent, a modest drop, all things considered.
Though a HIMSS survey found a 23 percent decrease in health IT professionals who expect their information technology budgets to rise this year, that means 55 percent still expect to spend more money on IT.
But health care IT spending in and of itself won’t create positive results for patients, argued Monday’s keynote speaker, George Halvorson, chairman and CEO of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals.
Halvorson said it would be “breathtakingly stupid” if health care used the influx of federal support for health IT to create isolated electronic systems that are just as confusing as their paper counterparts. “If we’re going to computerize IT, and do it as a nation, we need to tie it into interoperability,” he said.
Calls for interoperability are everywhere at HIMSS09; several speakers, including Sunday keynoter Dennis Quaid, urged attendees to work for national standards in the name of patient safety. It remains to be seen how successful those efforts will be.
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"Bare bones" budgets for now
by Matthew Weinstock @ 11:30AM
It should come as no surprise that the economy has slowed hospital spending on IT projects. According to the HIMSS Leadership Survey released at the conference this morning, 55 percent of respondents said that their IT budgets would increase in 2009, compared to 78 percent last year. And that’s despite the euphoria surrounding the stimulus package.
“It’s hard to think about incentives that are two to three years out,” Tim Zoph, CIO of Northwestern Memorial Healthcare, Chicago, said during a press briefing announcing the survey results. That’s because hospital leaders are focused on the immediate need for liquidity and the sagging economy. Denni McColm, CIO at Citizens Memorial Health in Bolivar, Mo., said she was asked to present a “bare bones” budget this year, with the expectation that things could change, especially when stimulus money becomes available. Zoph said he doesn’t expect to see a lot of activity across the industry for the next six to nine months; economists don’t expect rosier times before then either.
For hospitals that are moving forward, EMR and computerized provider order entry adoption top the charts, with 51 percent of survey respondents saying that clinical systems are their top priorities.
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An IT visionary
by Matthew Weinstock @ 8:00AM
Gregg Veltri, CIO at Denver Health, likes to talk about visionaries. He says hospitals need visionaries on their IT and medical staffs—people who can take your systems to the next level.
“In the old days—10 years ago—we had a few network and desktop support personnel,” Veltri told me when we sat down to talk this morning. “Now we are moving 500 terabytes a day. I need a cadre of IT visionaries, people who can see where we are going and invent new ways of doing things.”
One could make the case that Veltri is exactly that type of person. He presented Denver Health’s story at a Siemens-sponsored breakfast. Denver Health is not just a 400-bed hospital but also the city’s public health authority. So it also runs a detox center, health care in a correctional facility, 10 family health centers, 911 medical response and poison control. “Regardless of where you come into the system, you have one medical record,” he said, highlighting the organization’s ability to share data.
Denver Health has invested $400 million in health IT since 1996. Veltri is extremely proud of what the organization has accomplished and is pushing to do more. He’s talking with Siemens about sending information to patients’ cell phones and PDAs, such as reminders for patients with diabetes to check their glucose and then key in their results. The data would flow real-time to a doctor or case manager for follow-up. Already, the hospital is mining patient data to ensure that it is compliant with care management. Information is constantly pushed to physicians and then to patient navigators who help patients follow their care regimens. Veltri also foresees an IT system that can match a patient’s genetic markers with clinical decision support and design a personalized care plan. Keep in mind that this isn’t Mayo or the Cleveland Clinic. It’s a hospital that’s seeing its unsponsored care climb 15 percent per quarter. It has 10 percent of the beds in Denver but sees 40 percent of the area’s unsponsored cases.
This push toward more personalized medicine is exactly where Janet Dillione is taking Siemens Medical Solutions. The CEO of health services at the technology giant said Siemens is building its information system to be the foundation of personalized medicine. “We are in it for the long haul,” she said.
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Everybody's All-American patient safety champion
by Haydn Bush @ 2:00PM
Dennis Quaid gave a stirring keynote to open HIMSS09 Sunday afternoon, detailing his journey from a despondent parent during his twin infants’ life-or-death struggle following a medication error to his new role as an impassioned advocate of patient safety.
“I’m not involved in the health IT industry, so why am I here? I can only assume Doogie Howser was unavailable,” Quaid joked before turning serious.
In 2007, Quaid and his wife, Kimberly, took their 10-day old twins, Zoe Grace and Thomas Boone, to Cedars-Sinai Medical Center in Los Angeles after noticing irritation on Thomas’ belly button and Zoe’s finger. After they were hospitalized for observation, the babies twice received doses of 10,000 units of heparin, as two nurses confused the 10-unit bottle with the 10,000 unit bottle, Quaid said. The Quaids were sent home from the hospital long before the error was discovered, and around 9 p.m. that night, his wife “felt a hammer blow of dread.”
“She said, ‘They’re passing,’” Quaid said.
To reassure his wife, he called the hospital and was told that his children were fine. They were not—the overdose had turned their blood into the consistency of water, and both babies were bleeding from where they had been pricked earlier that day, Quaid said. The hospital did not discover the error until the next morning. “The next day was the most frightening of our lives,” Quaid said.
Forty-one hours after the accident, the babies’ blood began returning to normal, and the incident apparently passed without any permanent damage. But the near-tragedy led Quaid and his wife to become passionate patient safety champions. “If I make a mistake, it’s ‘Take 2 or 3 or 37,’” Quaid quipped. “If a caregiver makes a mistake, it costs someone their life.”
Quaid said he came to the realization that systemic failure, and not merely human error, lay behind the accident and many others like it, noting that the two heparin bottles could be easily confused by a nurse or physician. Since that time, Quaid said, Cedars-Sinai has implemented medication bar coding and a comprehensive electronic medical record—steps Quaid said he wants to see every hospital take. Noting the huge influx of health IT cash in the stimulus bill, he urged HIMSS attendees to help in efforts to achieve interoperability standards, which he said would ultimately benefit patient safety.
“The U.S. should lead the way,” Quaid said.
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Experts advise using coding shift to trump your competition
by Haydn Bush @ 11:30AM
Most hospitals are bracing for the large costs and productivity declines associated with the upcoming coding switch to ICD-10. But Mark Williams, director of client services for PricewaterhouseCoopers, says hospitals that are ready early may be able to gain a significant competitive advantage over those who wait until the last minute. With the CMS-mandated change still four years away, now is the time to assess the costs associated with the transition and create a plan for action, Williams said during a Sunday morning session on ICD-10.
“You need to prepare management for what kind of resource drain is necessary for the next three to four years, so they can budget appropriately,” he said.
Health systems that get their act together early may be able to buy struggling smaller organizations, Williams said. “This can be a possible opportunity for an advantage in your market.”
Coding touches nearly every aspect of a hospital’s operation, so a successful ICD-10 transition will require a thorough knowledge of the organization’s functions, Williams added.
Joseph Nicholson, chief medical officer for Blue Cross and Blue Shield of Oklahoma, urged providers and payers to use the next four years to organize and strengthen relationships with vendors and fully integrate IT shops that may be fragmented because of mergers and departmental differences.
“If you’re poised for the purchase or a large rollout of an older product that’s about to time out, you may have an unhappy conversation with your [IT] admin guy,” Nicholson said.
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IT and overalls?
by Haydn Bush @ 11:00AM
During a freewheeling town hall meeting on national health IT Sunday morning, Sen. Sheldon Whitehouse (D-R.I.) garnered a few chuckles by comparing the government’s massive health IT investment with its decades-long relationship with American farmers. Whitehouse said the regional centers that will help hospitals and doctors do the tough work of actually installing health IT improvements like EMRs will have a lot in common with the agricultural extension offices that have long helped farmers turn grant money into harvests.
“The program will operate like the agriculture extension model that’s popular in the red states,” Whitehouse said. “Think of it as a geek squad for doctors.”
As providers await the massive health IT investment from the stimulus package, Whitehouse noted that accountability on all ends will be critical to national progress. Peggy Welch, an oncology nurse at Bloomington (Ind.) Hospital who also serves in her state’s legislature as a representative, asked Whitehouse what the states should be doing to promote health information technology beyond merely “seeing dollar signs from the stimulus package.”
“Use your oversight,” Whitehouse said. “Drag in your HHS people and call hearings.”
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Is $19 billion enough?
by Matthew Weinstock @ 11:00AM
HIMSS traded the warmer climates of Orlando and San Diego for brisk Chicago for its annual conference and exhibition this year. Attendees didn’t quite get the same red carpet reception as the International Olympic Committee, which is also in town to evaluate the city’s bid to host the 2016 Summer Olympics, but the conference is humming along on its first day of meetings and exhibitor showcases.
The early buzz—and likely the theme of the meeting—is the American Recovery and Reinvestment Act of 2009, or as it is affectionately called here, ARRA. Obviously. All 25,000-plus attendees at this conference want a piece of that $19 billion in federal money. HIMSS scheduled 11 sessions across the conference’s four days solely on the stimulus package’s impact on health IT. In the first of these sessions, Rep. Tim Murphy (R-Pa.) said the $19 billion that Congress appropriated for health IT may not be enough. But both he and Massachusetts State Sen. Richard Moore, a Democrat, noted that technology is only one piece of the puzzle. Workflows and the entire patient care system have to be retooled. Both Murphy and Moore said the health care industry must show that information technology is in fact contributing to lower costs and, more importantly, improving the quality of care. Murphy also listed “Four I’s”—the technology must be: interoperable; interactive, meaning decision support and other functions are loaded in; integrated, meaning hospitals and physicians are linked with post-acute settings and disease management programs; and intelligent, so it learns physician prescribing practices and other trends.
| Comments: |
April 6, 2009 - Oh, yes! Throw money at the medical community to get them beholden to the government on our way to socialized European style medicine. Will they do this to the legal profession next? (Fat chance.) How about plumbers? I could use some government help to pay for my yard work. Yes, the government that brought us Social Security, Medicare and the tax code will do a bang up job of managing medical care. -Alvin A. Kahanek, quality management, San Antonio State Hospital |
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