December 16th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
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I am fortunate to work at an institution that has a fully deployed electronic medical record (EMR) system that incorporates outpatient physician notes and inpatient notes under one umbrella. By and large, patient care is facilitated since both outpatient and inpatient notes appear simultaneously in the patient’s chart, along side telephone messages and clinical results. While there are plenty of kinks to work out, most of us have to admit that there are huge patient care advantages to such a system.
The system also promotes a secure e-mail service for patients to e-mail their physician and a mechanism to have their results forwarded directly to them. With the ability to empower patients directly, many would consider this as the Utopian model for heath care delivery of the future.
And what could be better? Patients get virtually unlimited access to their health care provider, 24-7. Results are whisked to the patient. Speed. Efficiency. “Green.” It’s all good, right?
Maybe. Read more »
*This blog post was originally published at Dr. Wes*
December 13th, 2009 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
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We assume that technology will improve communication between doctors and patients.
But not always.
Look at the 2,000 word email.
While it isn’t yet the standard means of communication in our clinic (it will be soon) we occasionally take email from patients. My experience has been that they’re sometimes long and unfocused with tangential information irrelevant to the problem at hand. Read more »
*This blog post was originally published at 33 Charts*
November 16th, 2009 by Dr. Val Jones in Health Policy
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Someone I know works at a non-profit organization (supported by health insurers) that is trying to simplify the administrative processes in healthcare. He’s tasked with finding ways to make data transfer between doctors’ offices and health insurance companies more uniform and straightforward. His work is such a success that it was promoted to President Obama as a clear example of health insurers’ efforts to reduce waste and simplify healthcare. There is even talk of his project becoming mandated.
So why is this simplification strategy now in jeopardy of being tabled rather than legislated? Vendors and clearinghouses who exist to transfer data from one disparate health insurance bureaucracy and medical practice to another are fighting to block this progress because their business model is at risk. If health insurers and physicians can safely and efficiently exchange data – then they become less reliant on middle men.
One person’s waste (non-uniform, inefficient data exchange) is another’s (clearing houses and vendors) job security.
And we wonder why it’s so difficult to reform healthcare?
Sigh.
September 6th, 2009 by Dr. Val Jones in Book Reviews
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Preamble
I’ll never forget the day when I argued for protecting parents against misleading and false information about the treatment of autism. I was working at a large consumer health organization whose mission was to “empower patients with accurate information” so that they could take control of their health. My opposition was himself a physician who requested that our organization publish an article that advised parents of children with autism to seek out DAN! practitioners and chelation therapy.
I prepared my remarks with the utmost care and delivered them to a committee of our lay executives. I cited examples of children who had died during chelation treatments, explained exactly why there was no evidence that chelation therapy could improve the symptoms of autism and in fact was based on the false premise that “heavy metals” in vaccines were implicated in the etiology of the disease. I concluded that it would be irresponsible for the company to publish such misleading advice/information for parents, and would in fact be counter to our entire mission.
My physician opponent suggested that it was our company’s duty to inform parents of all their options, that we should not be judgmental about treatments, and that I was part of a paternalistic medical establishment that tried to silence creative thinking.
The committee ended up siding with my opponent. I was flabbergasted and asked one of the committee members what on earth they were thinking. She simply shrugged and said that my opponent was more likable than I was.
This experience marked the beginning of my journey towards fighting fire with fire – understanding that being right is not the same as being influential, and that “winning” an argument (where lives are on the line) requires a different skill set than I learned in my scientific training.
Book Review
And so it was with great interest that I picked up Randy Olson’s book, Don’t Be Such A Scientist: Talking Substance In An Age Of Style. I was pleased to see that other scientists had experienced the same revelation – that we need to be more communication-savvy to become more societally-influential.
Olson’s book outline is simple: four “don’ts” and one “do.” Don’t be so cerebral, literal-minded, poor at telling stories, or unlikeable. Do be the voice of science. He begins his book with a captivating story: a marine biologist goes to Hollywood and is shredded by an acting teacher for being incapable of raw emotion. Most scientists will get a good chuckle out of this narrative and will relate to Olson’s culture shock.
As the book winds along, the reader is introduced to a series of the author’s former girlfriends. He reminisces:
She would listen to me talk and talk and talk to the old folks and finally, by the end of the day, she would have had enough. So her favorite thing to do in the evening was, when I was done talking, to look deeply, romantically, lovingly into my eyes and say in a soft and seductive Germanic voice… “You bore me.”… p.82
Another girlfriend developed an affectionate nickname for me, “Chief Longwind,” which she would abbreviate when I’d get going on something and just say, “That’s enough for tonight, Chief.” p.83
Unfortunately, as these ladies noted, Olson’s strong suit is not compelling dialog – a tragic irony for a book written to inspire more effective science communication. Nonetheless, since scientists are rarely deterred by boredom, I think that there are some conceptual gems worth unearthing.
These are my top 5 take-home messages:
1. Communicate in a human way – be humorous, tell stories, don’t feel as if you have to present all the details. The goal is to get people curious enough to ask more questions.
2. Broad audiences prefer style over substance – learn to be bilingual (to speak with academics versus a general audience).
3. Marketing is critical for influence. The creators of Napoleon Dynamite spent a few hundred thousand dollars on production and $10 million on advertising/marketing. The movie grossed $50 million. Scientists who wish to be influential (or get their message across broadly) must bow the knee to the marketing gods.
4. Some people are naturally good communicators, others are not. Find the good ones and make them spokespeople. “The strongest voice is that of a single individual.” p. 166
5. Likability trumps everything. People make snap judgments about whether or not they like you, and your message’s impact is dependent upon your likability factor. Likability is related to humor, emotion, and passion. p. 148
And so, Don’t Be Such A Scientist offers some great food for thought – and I suppose if it hadn’t been written by a scientist it might also have been a more engaging read! But who am I to say, I’m still trying to bend my mind around the idea that Americans don’t care about facts.
April 7th, 2009 by Dr. Val Jones in Expert Interviews
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Network technology giant Cisco Systems, Inc. invited nurses to offer focus group feedback on a recent study that showed that 92% of nurses believe that communications lapses adversely affect patient safety. I joined five nurses in a cozy break out room at the HIMSS convention center and asked about their real-life experience with communications lapses in the hospital. Here are the highlights:
1. Technology Isn’t Perfect – although some hospitals have instituted bar code scanners and wireless computers to help to reduce errors, these devices often drop their connections. One nurse said that the devices actually slow down the process of distributing medications, and bypassing the system simply results in a loss of automated medication cross-checking. The devices don’t perform well in the case of an electrical surge, and nurses often waste time finding computers on wheels (affectionately known as “COWs”) that have a full battery.
2. Where’s The Patient? - the group of nurses all agreed that poor coordination of care inside the hospital can harm patients. Some nurses expressed frustration at having proceduralists and radiology teams remove the patients from their rooms without scheduling it with the nurses. They explained that nurses give out medications at specific times, and when the patients are taken to another part of the hospital without their knowledge, then they can’t plan to give them their medications appropriately. Missed doses or missed meals (for patients with diabetes for example) can result in dangerous hypoglycemic episodes, syncope, and various other harms.
3. Where’s The Pharmacist? – easy access to hospital pharmacists is critical for all clinical staff. One nurse relayed the shocking story of a med tech who was unable to get in touch with a hospital pharmacist to confirm I.V. zinc dosing in the NICU, and gave such an overdose that one of the premature babies died.
4. Where’s The Doctor? -during an audience poll at the Cisco booth, most nurses rated physicians as the hardest staff to get a hold of in the hospital setting. There is regular confusion about who’s on call, and there is often no direct line to call the physicians.
5. Where Are The Nurses Aides? – when it comes time to transfer patients (who are often very heavy) or move them in bed, nurses often have no way of finding peers to help them lift the patients safely. This results in wasted time searching for staff to assist, or even worse, can result in low back injury to the staff or patient falls.
6. Language Barriers - when patients are transitioned home from the hospital, they are often given complex instructions for self-care. These instructions are particularly hard to follow for patients whose native tongue is not English. Nurses see many re-admissions based on language-based miscommunications.
7. Decision Support Systems – one of the nurses suggested that a recent study showed that the number one source of clinical information for nurses was their peers. That means that nurses turn to other nurses for educational needs more often than they turn to a textbook or peer-reviewed source of information. Nurses would like to have better access to point-of-care decision support tools for their own educational benefit and the safety of patients.
8. Change of Shift – nurses identified shift changes as a primary source of communication errors. Technology that enables medication reconciliation is critical to safe continuation of inpatient treatment. One nurses said: “shift changes is when all the codes happen.”
And so I asked the nurses what their ideal technology would do for them to help address some of the communications problems that they’re currently having. This is what they’d like their technology to do:
1. All-In-One – nurses don’t want more devices to carry around. They want one simple device that can do everything.
2. Call a code – with one press of the button, the nurses would like the device to contact all staff who should participate in resusscitating a crashing patient.
3. Lab Values – nurses would like the device to alert them of all critical lab values on the patients under their care.
4. Clinical Prompts – nurses would like reminders of clinical tasks remaining for individual patients (e.g. check blood pressure on patient in bed 3)
5. Call and Locate Colleagues – the device should function as a full service cell phone with pre-programmed staff names/numbers and team paging lists
6. Locate Equipment -nurses would like to be able to track and locate wheelchairs, electronic blood pressure cuffs, and other equipment throughout the hospital.
7. Translate Verbal Orders To Written Orders – verbal orders are more prone to errors than written ones. An ideal device would have a voice recognition system in it that would translate physician orders to text.
Is there such a device on the market today? There are many different devices that have the capability to do some of above, but to my knowledge there is no device that can do it all yet. Companies like Cisco are working hard to provide integrated solutions for nurses – and the Nurse Connect phone is an important first step. What technologies would you recommend to nurses?
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More information about the phone (from press release):
Cisco Nurse Connect is a newly introduced solution that integrates nurse call applications, including Rauland-Borg’s Responder product lines, with Cisco Unified Wireless IP 7925G Phones to deliver nurse call alerts to mobile caregivers.
The Cisco 7925G Phone was specifically designed with the features necessary to support the unique safety and biohazard requirements of hospitals, including a battery that supports up to 13 hours of talk-time, ruggedized and hermetically sealed, and Bluetooth support for hands-free use.
The Nurse Connect Solution offers many benefits. For example, by reaching nurses on their mobile devices, the need to continually walk back to nursing stations or patient rooms is greatly reduced. Nurses can also have two-way communications with patients and send immediate requests to different levels of personnel after talking with the patient.
