Re: “How to Take Your Population Health Effort to the Next Level” by Bill Santamour in H&HN Daily, Dec. 2

As a hospital board member and a public health official, I think you are missing the fact that population health is not the sole responsibility of hospitals and health systems. It is a shared responsibility with public health. Data has always been critical, but hospitals shouldn’t be trying to get it and use it in a vacuum.

In the past, hospitals and health systems could focus solely on what happened within their four walls, get paid for treating illness and disease, and not worry about the overall health and wellness of the communities they served or were located in. In contrast, public health was supposed to be “moving the needle” on the community’s health with very limited funding and often little or no buy-in, support or involvement from the rest of the health system.

The new paradigm is that we all must work together to improve population health, which is the way it should have been all along. The factors that influence health are so broad and diverse that it takes all of us — hospitals and health systems, public health and many other partners of all sorts — working together to turn the tide on Americans’ health and wellness.

— Anne Goon

IT’s Missing Linkage

Re: “Why Your Hospital Should Ditch Your IT System” by Joe Flower in H&HN Daily, Nov. 20

This is a great topic for the future of medicine. As a nurse manager in my facility, there are many discussions about interoperability, especially regarding ICD-10 and meaningful use. Most of our physicians are private-practicing clinicians, and there is a concern about primary care physicians and hospital physicians communicating, especially in preventing readmissions. I read a little about cloud-based interoperability and thought the concept made a lot of sense.

Our facility has created a QCIPN — Queen’s Clinically Integrated Physician Network — to address [the Institute for Healthcare Improvement’s Triple Aim] and this has also made us look at systems integration in electronic health records.

— Michael Morimoto

2 Reasons Antibiotics Are Misused

Re” Don’t Underestimate the Threat of Antibiotic Overuse” by Bill Santamour in H&HN Daily, Nov. 20

While antibiotics are often ordered in a “we’ve always done it that way” or “that is how I was trained” manner, my observation is the root cause of overuse is a twofold lack of solid evidence-based treatment.

First is that often prescribers are not current with the literature and research and that, coupled with antibiotics being frequently ordered without a culture and sensitivity taken before the drugs are given, leaves a shotgun approach where they hope to hit something.

Second is educating the patients on the current evidence, which requires practitioners and nurses keeping up with research and current literature, in order to mitigate patient demand for antibiotics. For example, a parent ... expects a script for antibiotics for their child’s sore throat or otitis, even though the odds are the problem is viral. Despite the evidence, some practitioners still will not take a stand of antibiotic stewardship, and merely pull out the prescription pad.

— Scott Farris, R.N.

Docs’ Role in Strategic Planning

Re: “Five Overlooked, Key Strategic Planning Considerations” by Paul Keckley in H&HN Daily, Dec. 1

All excellent points, but beware the trap of just doing without truly engaging the medical staff in the important discussions above. There is a difference, and simply employing or talking to or incenting or punishing physicians does not really engage them in the discussion.

— Gaspere Geraci

Arguing for Arguments

Re: “The Power of a Good Argument” by Dan Beckham in H&HN Daily, Dec. 16

Too often, taking on the “argument” gets one ostracized or isolated (been there, had that done to me), because the “politeness” culture is simply too strong. Clearly, it is up to leadership to model and encourage productive argument and systematically build the culture needed to support it.

— Les D