The December 2010 Issue

Don’t Lose Sight of What Really Matters

By Paul Roemer

It is easy to remove oneself from what is important as we trade metaphorical tomatoes about what is wrong with EHR (electronic health records), what may happen to the healthcare reform, and why the nationwide health information network is DOA.  Debating healthcare IT on the Internet is an esoteric and antiseptic conversation, one with few – if any – catastrophic implications to anyone other than the person trying to sell a used $100 million EHR on eBay.

We discuss the fact that healthcare IT is supposed to benefit the patient.  Is there a more sterile word than “patient”?  Patients are faceless, nameless, and ubiquitous.  We calculate ROIs for EHR around people who exist to us only by their patient IDs.

What if these hominoid avatars turned out to be real people?

Two weeks ago I learned of a real patient: a friend, thirty-seven years old, a mother of three.  She has what is called Myelodysplastic Syndromes.  MDS sounds more polite.  One might think that because it has its own acronym it might imply good news.  It does not.

The thing I like best about Google is knowing that if an answer exists, I can find it.  I may have to vary the syntax of the query a few times, but sooner or later I will find what I seek.  The converse can be quite disquieting, especially if you happen to enter the phrase “survival rates for MDS.”  After a few tries, I realized that the reason I was not getting any hits to my query had nothing to do with poor syntax.  It had everything to do with a lack of survivors.

My friend has had thirty-eight Christmases.  Apparently, MDS is able to alter a simple mathematical series.  If presented with the numerical series 1, 2, 3. . .37, 38, 39 and asked to supply the next number, we would all offer the wrong answer: 40.  In my friend’s case, there may be no next number; the series will likely end with 39.  That’s MDS math.

Then there are her three children, each one of them in the same grade as my three children.  They will be learning a different version of MDS math.  All the numerical series in their lives will reset and begin again with the value of one.  “First Christmas since Mom died….  First birthday since Mom died….”  Every life event will be dated based on its relationship to an awful life-ending event.

EHR probably has very little value when you break it down to the level of an individual patient.  Stalin said something like, “One death is a tragedy, and a thousand deaths is a statistic.”  While it is unlikely that he was discussing patient outcomes, the import is the same.

It’s important to remember that as we debate things that we view as being crucial components of healthcare, when it comes down to someone you know who probably is not going to get better, certain things do not seem very important.

Paul Roemer is a healthcare strategist and the managing partner of Healthcare IT Strategy, which helps healthcare providers solve business problems using EHR, workflow improvement, and change management.  This November 29, 2010 blog post is taken from on Wellsphere, Health Knowledge Made Personal.


Medical Call Centers: Benefits for Both Physicians and Patients

By Tina Minnick and Roger Brooksbank, MD, FACEP

To achieve business goals, physician practices must focus on services that provide value and identify improvements that enhance quality while driving down cost – all while maximizing the patient experience through quality outcomes and high-touch experiences.

These challenges raise an important question: How can physicians do more with fewer resources when serving their patients?  For many physician groups, the solutions offered by medical call centers may be the answer.  Patient contact programs orchestrated through a medical call center are a valuable extension of patient satisfaction efforts, and they also enhance patient care, quality outcomes, and risk-management measures.

Physician after-hours call services aid in the recruitment and retention of physician talent in today’s difficult environment.  High demand and low supply have created the need to offer additional benefits in order to meet recruitment goals.  Using an after-hours call service provides peace of mind and improves quality of life for physicians.  During evenings and weekends, patient calls can be routed to nurses who triage calls and document the information.  The information is then shared with the physician practice for EMR entry.  A medical call center’s consistent execution of algorithm-based guidelines, adherence to quality standards, and advice record documentation of after-hours calls may also reduce risk exposure for physicians.

Additional benefits of after-hours call services include:

  • Increased patient satisfaction
  • 24/7/365 coverage
  • Early intervention and access to the appropriate level of care
  • Improved patient health through follow-up and education

Recent discussions surrounding healthcare reform have resulted in healthcare organizations being more proactive with patient care, patient safety, revenue growth, and reimbursement strategies related to quality outcomes and the patient experience.  Forward-thinking organizations are not only seeking to understand the relationship between patient communication and reform, they are forging it.

Tina Minnick is responsible for client development, public relations, and marketing for the TeamHealth Medical Call Center.  She can be reached at 865-985-7313 or  Roger Brooksbank, MD, FACEP, is the medical director of primary care and the regional medical director of emergency services for TeamHealth Midsouth. 


National Certification for Medical Interpreters Marks First Anniversary

Great strides have been made since the National Board of Certification for Medical Interpreters launched the first national certification for medical interpreters one year ago, and limited-English-speaking patients are reaping the rewards.  Nearly 500 candidates have registered for the certification exams; more than eighty Certified Medical Interpreter (CMI) credentials have been granted.  Additionally, the National Registry of Certified Medical Interpreters has an online tool listing certified interpreters.

“With the designation of each CMI, we are… helping to improve patient safety for limited-English speakers,” said Dr. Nelva Lee, chair of the National Board of Certification for Medical Interpreters.  “We’ve made tremendous progress in the past twelve months, and we are especially encouraged by the growing support from hospitals.”

For example, Children’s Medical Center in Dallas, Texas, is the first hospital to offer reimbursement for its staff of interpreters who take and pass the national certification exams.  “Many of our interpreters are taking their place at the front of the line and have registered for the certification exams,” said Edgardo Garcia, director of Language Access Services.  “Our support of this national standard is best illustrated by the CMI pin we’ve developed so that our interpreters stand out and can be recognized throughout our organization.”


New York to Create Country’s Largest EMR Network

The New York Department of Health (DOH) and public/private partnership New York eHealth Collaborative presented a plan to change the face of healthcare for all New Yorkers by creating the country’s largest network for electronic medical records.  The plan, submitted to the Office of National Coordinator for Health Information Technology, outlines a vision to spend $129 million in state and federal funds to build and implement a statewide medical records network that will serve hospitals, medical practitioners, and up to 20 million patients a year.  The proposed statewide network will link together several existing regional electronic medical record networks with new infrastructure and programming.

Once completed, New York doctors – from anywhere in the state – will have instant access to critical medical records of every patient, eliminating the confusion and vital time that often accompanies the sharing of medical records between different healthcare providers.  While several other states and the Veterans Administration have set up large networks for medical records, New York’s system will ultimately dwarf them when completed given the scope of the state’s medical facilities.

“This statewide network will empower healthcare providers by giving them access to a wealth of patient data that they didn’t always have at their fingertips,” said David Whitlinger, executive director of NYeC.  “While cutting-edge technology plays a tremendous role in modern medicine, in many respects medical records are still stuck in the past.”


Holiday Season Alcohol Abuse Can Lead to ER Visits, Even Death

The holiday season is a wonderful time, but it’s also a time to remember safety when it comes to drinking alcohol.  The nation’s emergency physicians warn against excessive alcohol consumption and urge people to use good judgment.  According to the Centers for Disease Control and Prevention, 79,000 deaths occur annually as a direct result of excessive alcohol use.

“Very few things are more heartbreaking than to see a family suffer the loss of a loved one because of an alcohol-related tragedy during the holidays,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians.  “Alcohol-related injuries are not always driving-related incidents like some may assume.”  Emergency physicians see alcohol-related injuries such as serious falls while stringing lights, the improper use of power tools, and performing tasks that require significant amounts of balance.

Additionally, some people can also be affected by a condition known as “holiday heart syndrome.”  This condition is basically an irregular heartbeat pattern that may develop largely because of excessive drinking in otherwise healthy individuals.

Of course, drunk driving is a major concern.  “Drunk driving is 100 percent preventable,” said Dr. Schneider.  “Don’t get behind the wheel of a car if you’ve had too much to drink.”


NMA Supports FCC Net Neutrality Proposal; Sees Positive Impact on Telehealth

On December 1, the Federal Communications Commission (FCC) released details about its net neutrality proposal to be considered in December.  Kweisi Mfume, executive director of the National Medical Association (NMA), said, “Based on today’s announcement by the Federal Communications Commission, the National Medical Association believes the FCC is acting prudently by working to develop a middle ground solution for net neutrality rules applied to the Internet, and our organization is encouraged by remarks indicating that the final proposal will steer clear of extreme measures, such as the path of Title II reclassification.

“If approved, a compromise would enable and promote wider adoption of healthcare solutions, services, and information through use of the Internet.  Healthcare costs are reduced through such technologies, and new offerings powered by the Internet allow for better monitoring and care of chronic diseases disproportionately impacting the urban and rural communities.

“Reaching agreement on net neutrality would stimulate further investment in telemedicine technologies, bring affordable access to more Americans, and work to eliminate healthcare disparities in underserved communities.  The NMA views the FCC’s announcement today as a path toward careful consideration to preserve an open Internet, while ensuring access to the many vital benefits offered by broadband.”


Workplace Clinics: A Sign of Growing Employer Interest in Wellness

Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services, according to a new study by the Center for Studying Health System Change (HSC).

Many experts interviewed for the study said most workplace clinics try to achieve a “trusted clinician” primary care model that offers much shorter appointment and in-office wait times and much longer clinician-patient encounters.  Experts said that longer clinic visits allow the clinician – sometimes, but not always, a physician – to listen to patients, diagnose their conditions, and discuss different treatment options with them.  In addition, the clinician has time to screen for other problems unrelated to the immediate visit.

Commonly identified workplace clinic themes include:

  • The trusted clinician model of wellness/primary care delivery hinges on having the right staff.
  • No matter who runs the clinic, sustained employer engagement is critical to success.
  • Gaining employee trust is key to clinic acceptance.
  • Investing in the appropriate scope and scale of clinic services is challenging but essential.
  • Employers should be realistic about ROI and recognize that measurement poses challenges.


Stony Brook Selects Smartphone Messaging Solution

Stony Brook University Medical Center, in Stony Brook, New York, has selected Amcom Mobile Connect for its pager replacement and smartphone messaging system.  Stony Brook chose the solution because of its ability to manage a high volume of messages spanning 3,000 BlackBerry smartphones facility-wide.  The medical center will also benefit from encrypted messages and full visibility and traceability of all message activity.  This will include time and date stamps showing when messages are sent, delivered, and opened, as well as when responses are sent and the information contained in each response.

The smartphone messaging solution will integrate with Stony Brook’s existing solutions.  These are in use for the hospital contact center, emergency notification, on-call scheduling, and speech recognition.  A fully integrated system means that a single source of accurate contact information and on-call calendars will be accessible at all times to promote staff efficiency and patient safety.  As an example, if contact center personnel need to notify a trauma team of an emergency, they can send a group notification message to the appropriate staff members’ smartphones just as they would pagers.