May 3rd, 2009 by KevinMD in Better Health Network
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Bolstered by the stimulus, there’s no doubt that there’s a significant push for doctors and hospitals to adopt digital medical records.
I’ve written before how we’re essentially throwing money at Windows 95 technology, but now, as an article from BusinessWeek points out, there’s a real danger in moving too fast.
Somewhat under-publicized were the incompatibilities with older systems in the Geisinger Health System, which after spending $35 million on software, noticed a spike medication errors that required another $2 million to fix.
Or what happened at the University of Pennsylvania, which found medication errors stemming from software designed to prevent mistakes.
Worse, there is no national database tracking the errors that are caused from electronic medical records. Because most of the programs are not open-source, confidentiality agreements meant to protect proprietary technology also serve to hide mistakes.
Ideally, these issues need to be resolved before throwing more money into bad technology. But, because of the intuitive notion that technology automatically improves health care, no one seems to be advocating a more cautious route which may, in actuality, better serve patients.
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Better Health Editor’s Note: Please read this post for more in-depth coverage of how difficult it is to transfer health records electronically.
May 1st, 2009 by Dr. Val Jones in Expert Interviews
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I recently interviewed the CEO (Bill Reed) and SVP (Stuart Segal) of AllOne Health at the World Health Care Congress. Their enthusiasm for mobile technology rivals Better Health’s own Dr. Alan Dappen. Will mobile technology get people more engaged in healthy behaviors and assist with disease management? I hope so.
Dr. Val: What is “All One Health?”
Reed: All One Health provides a bundle of customized offerings to small employers – including insurance and health and wellness programs. We provide the same kinds of benefits that large insurers offer to large employers except we spend a lot of time analyzing the specific needs of small companies before initiating a health program for them. Some small companies have employees with diabetes-related challenges, and others might be more concerned about asthma. We also use predictive modeling (health risk assessments) to help the companies customize preventive health strategies for their employees.
Engagement and compliance are very important in bringing about substantive changes in healthcare – and good health can be incentivized by employers. All One Mobile is our means for connecting patients (or employees) with health coaches and nurses, which we believe is critical for affecting lifestyle changes.
Dr. Val: What does your “menu of services” look like from the employee’s perspective?
Reed: Each employee begins the relationship with a health risk assessment (HRA). That HRA recommends programs for the employee based on their risk factors, and prioritizes the top three things for them to work on. There are performance trackers linked to employer incentives for health improvements and the programs are available via the phone so that employees don’t have to be in front of their PC to interact with their health coaches. We have proactive outbound calling with an opt out feature. We believe that the mobile phone is critical for encouraging consistent participation in health programs. Our services center on phone-based reminders and personal relationships with coaches.
In the near future we’ll include blue tooth technology to have patients upload data from their home monitoring devices for their coaches to review. This is a more proactive approach to health management.
Dr. Val: And Stuart, tell me about the All One Mobile program for the Department of Defense (DOD).
Segal: The DOD was having difficulty with follow up care for military personnel returning from Iraq and Afghanistan with traumatic brain injuries (TBI). Once they returned to their communities, it was very hard to reach them. All One Mobile won a contract with the army to provide constant messaging services to soldiers with TBI because they need regular reminders to keep their rehabilitation on track. Army case managers can push out questionnaires to soldiers and depending on how they answer, the case manager might be triggered to give them a call while they have the phone in their hand. So the phone-based communication tool is the primary tracking device for soldiers who return to the US with TBI.
Dr. Val: What are the educational qualifications of your coaches?
Reed: Registered nurses, dieticians, and psychologists.
Dr. Val: And what if the patient needs to see a doctor?
The coaches are trained to refer patients to their doctor when it appears that they need it. We can also track their prescription patterns and send the patients a “gaps in care” letter to remind them to fill their prescriptions. Non-compliance with medications is a major problem that All One Health can address.
Dr. Val: How would a doctor use All One Mobile?
Segal: We’re currently working on making EMRs accessible via phones – so that no matter where a physician is, he or she can review patient records and track their progress remotely.
Dr. Val: Or better yet, when one doctor is taking call for her group, she can have access to patient records so that when she’s called in the middle of the night, she’ll be fully informed about the patient problem list and understand the context of the concerns much better.
Segal: Yes, and All One Mobile can be used in the Emergency Department setting – so that when patients are discharged home, they receive 30 days of our service. The hospital can send them their lab results (that were drawn in the ER) and easily contact patients to bring them back in if necessary. In addition the patients can take photos of their wounds, for example, and have the physicians see how they’re progressing.
Dr. Val: Any closing thoughts?
Reed: This kind of health communication is incredibly convenient. Patients don’t need to carry around a smart card, a thumb drive, or a paper record. They’re already carrying around what they need – their own cell phone. And almost everyone in the US, regardless of economic class or age, has a phone.
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.
