Sharing Records Called Key to VA Healthcare

In a recent Arizona Republic front-page article (9/2/14), it seems a key reason for the delay in VA healthcare and claims processing is due to the inability for the Department of Defense and the VA to share electronic health records efficiently.

"A July audit by the Defense Department's inspector general found that the Defense Department failed to make proper records transfers to the VA. In the Army, 77 percent of records transferred in 2013 were not timely and 28 percent were not complete."

A key part of the problem is the VA's reliance on old technology. A report released last week by the VA's Office of Inspector General criticized the agency's out-of-date scheduling system. The system has come under fire repeatedly since The Arizona Republic disclosed in April that veterans were dying while awaiting appointments for care.
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In addition to all the problems plaguing the VA, old technology and an inability to transfer records from the DoD adds to the inefficiencies and time delays among VA patients. The Defense Department plans to buy a new system, while the VA intends to modernize its own in-house design.  But modernization still takes time.

Any ideas about what the VA should do?  Are they even capable of doing it in-house?

Where to find good health-related articles?

One of the best places to look for recent healthcare news, or topics in the news are Healthcare blogs.  On the right side of this blog is my BLOG LIST of a few good ones, but I'm sure there are more.

Please comment below on this blog or on our Facebook Group for other good sources you've found (that didn't involve an extensive Google search).  After all Google searches only account for like 20% of the web.

That is, unless you know how to be a more sophisticated user of Google search.  Go to http://www.avatargeneration.com/2012/11/tips-for-students-doing-online-research/ for details.

How Many Die from Medical Mistakes?

"How Many Die From Medical Mistakes," watch this video to give you a more detailed context of the problem:

“Your Hospital May Be Hazardous To Your Health,” co-published with PBS Frontline as part of a five-day hackathon that brought together teams of journalists, filmmakers, developers and designers to produce interactive stories for the Web.

The piece draws from ongoing reporting about patient safety by ProPublica reporters Marshall Allen and Olga Pierce. "Our collaborators were documentary filmmakers Tom Jennings and Sabrina Shankman and Director of Development Sam Bailey, all with Frontline, and a team from Ocupop, a web design and development group based in Milwaukee, Wisconsin."

Comments?

Why American Health Care is So Pricey

Americans pay more for health care than people in many other developed countries, and Elisabeth Rosenthal is trying to find out why. The New York Times correspondent is spending a year investigating the high cost of health care. The first article in her series, "Paying Till It Hurts," examined what the high cost of colonoscopies reveals about our health care system; the second explained why the American way of birth is the costliest in the world; and the third, published this week in The Times, told the story of one man who found it cheaper to fly to Belgium and have his hip replaced there, than to have the surgery performed in the U.S.

To hear the Fresh Air interview with Elisabeth Rosenthal, to go http://www.npr.org/2013/08/07/209585018/paying-till-it-hurts-why-american-health-care-is-so-pricey

Hospital Charges in US Vary Wildly

As discussed in the Time article on "The Bitter Pill", the government is publicly revealing how much hospitals charge, and the differences are astounding: Some bill tens of thousands of dollars more than others for the same treatment, even within the same city.

 For example, the average charges for joint replacement range from about $5,300 at an Ada, Okla., hospital to $223,000 in Monterey Park, Calif., the Department of Health and Human Services said. That doesn't include doctors' fees.

 "It doesn't make sense," Jonathan Blum, Medicare deputy administrator, said Wednesday. The higher charges don't reflect better care, he said. Blum said the Obama administration hopes that releasing the information, at www.cms.gov online, will help lead to answers to the riddle of hospital pricing - and pressure some hospitals to lower their charges.

 The database also will help consumers shop around, he said. "Hospitals that charge two or three times the going rate will rightfully face scrutiny," Health and Human Services Secretary Kathleen Sebelius told reporters. Moreover, consumers will get insight into a mystifying system that too often leaves them with little way of knowing what a hospital will charge or what their insurance companies are paying for treatments, Sebelius said.

Here are hospital charges in Tucson:

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A usability issue: Medical devices constantly beeping

I found this article in the AZ Daily Star on an AP report about delays in treatment due to medical devices constantly beeping.   The article goes on to say that hospital workers are "desensitized" to the beeping and so ignore the noise, leading to "at least two dozen deaths a year on average," a hospital accrediting group reported.  Like alert fatigue, where clinicians ignore alerts because they get so many of them that they override them (a simple workaround).   The beeping devices include those that measure blood pressure and heart rate, among other things. Some beep when there's an emergency, and some beep when they're not working. That can lead to noise fatigue and the delay in treating a patient can endanger lives, the accreditation commission says.

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TQM and Physician Involvement

In the case we read about Virgina Mason's use of Toyota's Production System (TPS) and the associated management philosophy of Total Quality Management, which was adopted widely among health care delivery organizations in the early to mid 1990s (p. 5 in case).  Experience with these techniques was mixed, with some observers arguing that TQM was not applied correctly in health care and others arguing that the approach was ill suited to an industry in which the underlying science was based on biology not physics, cause and effect relationships were poorly understood and the primary worker (the doctor) was only loosely affiliated with the organization.

In a 2003 survey by Casalino and colleagues found that even after more than a decade of focus on process improvement, physician groups’ use of the of tools for process management, such as clinical practice guidelines, disease registries, and performance measurement and benchmarking was limited.

One important factor in whether or not TQM gained traction in a health care delivery organization and was effective was physicians’ involvement in hospital governance. The alignment between physicians and the health care delivery organization (defined as “the degree to which physicians and organized delivery systems share the same mission and vision, goals and objectives, and strategies, and work toward their accomplishment”) was an important determinant of whether physicians adopted a range of clinical management practices aimed at improving clinical performance.

We will next read how Intermountain Healthcare changed clinical operations.  As an example of how Intermountain uses lean management strategies, here is a video that gives you an idea of how early attempts at TQM can work today.

L. Casalino, R.R. Gillies, S.M. Shortell et al.,“External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients With Chronic Diseases,” JAMA (2003), 289, 434-441.