Tim Cromwell’s mother-in-law is 86 years old. Her husband is a Korean War veteran who developed Alzheimer’s disease, and receives care from both the VA and private healthcare providers. Because she and her husband take so many medications, they actually replaced their dining room table centerpiece with a collection of orange and white pill bottles. Mrs. Spencer keeps a hard copy of all of her husband’s medical records in a large file box that she carries with her on a cart with wheels. She has no alternative for keeping all her husband’s providers up to date with his complex care, and lifting and transporting the records has become more difficult for her in her eighth decade.
If this story sounds all too familiar, then you’ll be glad to know that the government is facilitating electronic medical and pharmacy records portability. One day it may be possible for Americans to dispose of those hard copy files, knowing that any provider anywhere can access their records as requested.
Tim Cromwell is passionate about alleviating his mother-in-law’s need to carry medical records around, and believes the way to do this is through the US Department of Veterans Affairs’ participation in the Nationwide Health Information Network (NHIN). Working in compliance with NHIN standards, the Federal Health Architecture group recently oversaw the creation of software (called CONNECT) that creates a seamless, secure and private interface with hospitals, and over 20 federal agencies’ medical records systems (including the Social Security Administration, Department of Defense, Veterans Affairs, the Centers for Disease Control and Prevention, and the National Cancer Institute).
On April 6, 2009, NHIN released the CONNECT software necessary to make Electronic Medical Records systems interoperable. The software is “open-source” and free to all who’d like to incorporate it into their EMRs. Those who add the free software will be able to share data with NHIN’s member groups, which include early adopters like the Cleveland Clinic, Kaiser Permanente, Beth Israel Deaconness Medcial Center, and MedVirginia.
This means that if Mrs. Spencer and her husband receive their care from participating hospitals and federal programs, they’ll never have to tote paper records again. But it may take some nudging from patients and healthcare professionals like you to grow the network. If you’d like your hospital to participate in the NHIN network, encourage them to view the NHIN website here.
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?
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.
I had another exciting day at HIMSS today in Chicago. I interviewed a team of nurses about hospital communications lapses, met with the COO of Healthline, the CMIO of Elsevier, HHS’s National Coordinator, Dr. Rob Kolodner, and had dinner with Rich Carmona, the 17th Surgeon General of the United States. I have about 10 blog posts that I need to publish about all of the above – but just wanted to mention one of the funniest things that happened.
I nervously approached Dr. Rob Kolodner with my husband in tow today, wondering what interesting thing I could possibly say to the father of health IT interoperability (we had never met in person before). Just as I was searching for an interesting opening line, Dr. Kolodner says to me:
“Oh you’re Val Jones! I have your shirt!”
Of all the things Dr. Kolodner could have said to me, that was NOT what I was expecting. I smiled quizzically at him, trying desperately to figure out how he’d come to possess one of my shirts. My husband shot me a sideways glance. Fortunately for me, Rob didn’t leave me confused for more than a few (very long) seconds.
“You’re the cartoonist… I picked up one of your t-shirts at the Health 2.0 conference last year. It’s really funny.”
“Oh, I see…” I chortled. “You must have the one of the ER nurse who can’t read the doctor’s handwriting.”
“That’s the one!” said Kolodner, beaming. “I got one for my friend who’s an ER doc.”
And so I asked my husband to take the photo of us above.
My husband just shook his head… I think we met my first fan.
The prospect of standing in a small booth on a cement floor for 5 days led my husband and me on a quest for cushioned shoes. We found a local department store near our hotel and proceeded to purchase what we hoped would protect us from inevetable foot and back pain.
Since I chose flat dress shoes, I also needed some knee-high stockings to prevent blisters. Hubby exhibited all of the normal male signs of discomfort as I asked him to join me in the hosiery department. He listened quietly as the sales lady walked me through the stocking “decision tree” – color, thickness, pattern, price were all part of choosing the appropriate stocking.
I navigated my way towards a sheer option without too much difficulty and was about to check out when my husband whispered quizzically in my ear,
“What’s a rain forest stocking?”
My mental cogs and wheels turned furiously as I tried to determine the correct answer.
“Honey, I have no idea what that is. Why do you ask?”
“Well, the sales lady kept asking you if you wanted sheer or rain forest stockings…”
I burst out laughing.
“Um… she was saying, ‘sheer’ or ‘reinforced’ toe stockings, I think.”
I suspect my husband will never accompany me to the hosiery department again.
My husband Steve and I are at the HIMSS (Healthcare Information and Management Systems Society) conference in Chicago. There are about 30,000 attendees this year and the event is being promoted on billboards around the city and in hotels within a 3 mile radius of McCormick Place. Since President Obama has set aside 20 billion dollars for electronic medical records creation and adoption, members of HIMSS have responded with jubilation (and perhaps even some salivation).
The HIMSS conference might strike outsiders as a kind of Star Trek convention without the costumes. The 881 exhibitors in attendance range from health technology giants like GE, Philips, and IBM to small EMR start ups and software engineering companies to facilitate patient care. There is even a “village” on the convention center floor devoted to demonstrating inter-operability of data systems. Standards organizations like NIST, non-profits like CAQH, and government agencies like the CDC are aggregated together at booths on a huge blue carpet – all working together to share information in formats that their computers can all recognize.
As I looked out on this sea of exhibits, the size and scope of the healthcare industry really struck me. I had been to medical conventions at McCormick place before (the AAFP meeting was there last year, for example), but this time it was filled, floor-to-ceiling, with companies that were not (with few exceptions) hospitals, provider groups, pharmaceutical companies or insurers. Instead, this was an entire additional array of companies, all making a living on healthcare.
The exhibit hall opens today at 2pm, and I’ll be at the conference through April 8th, blogging and Twittering (follow me on Twitter here) my thoughts and discoveries. I’ve got my dark suit, comfortable shoes, and pocket protector in place.
May we all live long and prosper.