April 16th, 2009 by Dr. Val Jones in Opinion
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I’ve been covering a lot of health and medical conferences lately, and experiencing a wide range of reactions to my work. For those in the media who “get” blogging – I’m treated with honor and respect. One conference organizer kindly lined up the key note speakers for me to interview, not allowing them to leave until I’d asked them all the questions I desired.
A different conference PR team forbade me to Twitter during the conference believing that “Twittering” was code for recording the conference and selling it to those who didn’t want to pay the high attendance fees. One CEO enthusiastically beckoned me over to speak with him (seeing my bright green press ribbon) and then looked at my title “blogger” and said in an irritated voice, “oh, you’re not real press.” At yet another conference I was invited as press and then asked to pay $30/day for Internet access. When I asked if I could interview the keynotes I was told, “I’m sure they won’t want to talk to you.”
As you can see, my experience has varied from being treated like a second class citizen, to being critical to the PR strategy. As a physician and a member of the National Press Club, I find it amusing to be “shattering the categories” in all kinds of ways. Most people find it hard to reconcile that I’m a “real doctor” who is also a full time blogger. I see patients once a week, and I cover conferences/conduct interviews/evaluate news on my blog the rest of the time. “But you can’t be a real doctor,” they say, peering at my press badge, “you don’t look like one.”
For PR and communications strategist in the know, medical bloggers are powerful way to reach their target audience. Better Health, with its partner sites and blogger network, reaches over 11 million unique viewers per month. As the CEO, I have been invited to speak at AMA sponsored conferences, on CBS and ABC news, at the National Library of Medicine, and have been quoted by the Wall Street Journal, and LA Times. A PR executive told me recently, “forget the Today Show, Better Health reaches a larger and more targeted health demographic.”
And yet, blogging and new media are ahead of industry, traditional PR, and communications efforts in healthcare in terms of reach and influence. Very few have figured out how to work with medical bloggers in any consistent way, even though there’s a great new channel to do so: the Better Health network.
As I have often said, blogging is upstream of mainstream media. It’s a great place to be, though misunderstood by some. I’ve grown a thick skin and expect confused looks – because I know that in a year or so, medical bloggers will be an integral part of health conference coverage, probably upstaging their current mainstream counterparts. One day soon blog networks like Better Health will be in a position to hire journalists as part of a new hybrid team of reporters and scientists, better able than ever to communicate the significance of health news.
Imagine getting immediate commentary from a researcher who understands the complex science behind a medical breakthrough? Even the best health writers are often ill-equipped to know how to interpret author spin or biostatistics. But by combining those trained in journalism with those trained in medicine – and producing content that is conversational and accurate – readers gain access to a deeper understanding of health information. The old journalism mantra “we report, you decide” becomes “we interpret, you decide.” And for those without a medical background, the interpretation can add tremendous value.
As the world adapts to the Internet age, watch for a fundamental shift in the way health information is reported. Adding physician, nurse, and scientist writers into the mix will only enhance the quality of what we read. In a world grieving the loss of newspapers and health beats, I remain optimistic – because I believe we’re on the verge of a rebirth in health communications, and we’ll all be better for it.
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.
April 7th, 2009 by Dr. Val Jones in Announcements, Expert Interviews, Health Policy, True Stories
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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.
April 5th, 2009 by Dr. Val Jones in News
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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.
March 20th, 2009 by Dr. Val Jones in Health Policy
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What would it be like to have most of healthcare’s key stakeholders in one room, and allow each of them to take turns at a podium in 3 minute intervals? It would be like the meeting I attended today at the Institute of Medicine.
The goal of this public forum was to allow all interested Americans to weigh in on prioritization rankings for comparative clinical effectiveness research (CCER). CCER, as you may recall from my recent blog post on the subject, is the government’s new initiative to try to establish “what works and what doesn’t” in medicine. Instead of answering the usual FDA question of “is this treatment safe and effective?” We will now be asking, “is this treatment more safe or more effective than the one(s) we already have?”
There are many different treatments we could study – but let’s face it, 1.1 billion isn’t a whole lot when you consider that some CCER studies (like the ALLHAT trial) cost upwards of 100 million a piece. So we have to think long and hard about where to channel our limited resources, and which treatments or practices we want to compare first.
The public forum attracted most of the usual suspects: professional societies, research organizations, industry stakeholders, health plans, and advocacy groups. But the imposed time limit forced them to really crystallize their views and agendas in a way I’d never seen before.
I “live-blogged” the event on Twitter today and if you’d like to see the detailed quotes from all the presenters, feel free to wade through the couple of hundred comments here.
For those of you more interested in the “big picture” I’ll summarize my take home points for you:
Almost everyone agreed that…
- The process for establishing research priorities should be transparent and inclusive of all opinions.
- More information is good, and that CCER is a valuable enterprise insofar as it provides greater insight into best practices for disease management.
Most agreed that…
- Preventive health research should be a priority – so that we can find out how to head off chronic disease earlier in life.
- CCER should be considered separately from cost effectiveness decisions.
- One size doesn’t fit all when it comes to patient needs and best disease treatments.
- Physicians should be included in the CCER research and clinical application of the findings.
- Research must include women and minorities.
- CCER should not just be about head-to-head drug studies, but about comparing care delivery models and studying approaches to patient behavior modification.
- CCER should build upon currently available data – and that all those who are collecting data should share it as much as possible.
Some agreed that…
- There is a lack of consistent methodology in conducting CCER.
- We need to be very careful in concluding cause and effects from CCER alone.
The best organized 3 minute presentations:
In my opinion, the industry folks had the best presentations, followed by a powerful and witty 3 minutes from the American Association for Dental Research. Who knew the dentists had such a great sense of humor? Here are the top 4 presentations:
#1. Teresa Lee, AdvaMed – best all around pitch. In three short minutes, Teresa persuasively argued for transparency in CCER priority-setting, presented her top disease research picks (including hospital acquired infections and chronic diseases like asthma, diabetes, and clinical depression), the importance of physicians and patients making shared decisions about care (rather than the government imposing it), and the need to distinguish CCER from cost effectiveness.
#2. Randy Burkholder, PhRMA – “Without physician input, the questions we pose via CCER will not be clinically relevant.”
#3. Ted Buckley, BIO – “What’s best for the average patient is not necessarily best for every specific patient.”
#4. Christopher Fox, American Association for Dental Research – he said that “his good oral hygiene made it possible for him to deliver his presentation today.”
Most innovative idea
Dr. Erick Turner of Oregon Health and Science University suggested that FDA trial data be used as the primary source of CCER-related data analysis rather than the published, peer-reviewed literature since journals engage in publication bias – they tend to publish positive studies only.
Most shocking moment
Merrill Goozner, from the Center for Science In The Public Interest, essentially told the public forum hosts that the event was a terrible idea. He suggested that industry stakeholders were inherently biased by profit motives and should therefore not be allowed to influence the IOM’s CCER priority list. The crowd squirmed in its seats. For me, Merrill’s suggestion was like saying that a plan to reform the auto industry should exclude car manufacturers because they have a profit motive. Sure profit is a part of it, but reform is just not going to happen without buy in and collaboration. As I’ve argued before – there’s no such thing as complete lack of bias on anyone’s part (patients, doctors, nurses, dentists, health plans, advocates, or industry). The best we can do is be transparent about our biases and include checks and balances along the way – such as inviting all of us biased folks to the table at once.
I’m glad that happened.
