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."

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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:

Read on...

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.

Read on...

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.

The Direct Project: Exchanging Health Information Over the Cloud

I found this site at IBM Developer about the Direct Project.  This is a cloud-based, open source, Java-based client that allows secure email to be sent in health IT systems.   The articles starts by stating,

"Cloud computing has been a game-changer in promoting system interoperability and reducing IT costs in almost every other industry, but it has been difficult to adopt the cloud computing paradigm for health IT. Today, health IT in the cloud is mostly limited to hosted electronic health record (EHR) providers for small practices such as eClinicalWorks and PracticeFusion (see Resources)   Such providers focus on hosting data and services (in the software-as-a-service or SaaS model), but not on data exchange. Large hospital systems have so far not adopted cloud computing in any meaningful way."

The article provides great technical and practical information about the history of Direct, how it works, and the challenges it faces.  There are also links to other resources.

New ACO expands in Tucson

In today's Arizona Daily Star, the headline reads, "New 'accountable' model of health care expands here."  I mentioned in class that TMC had an ACO, called Arizona Connected Care.  The CIO is a UA Masters in MIS alum, Michael Griffis.  You can check him out on LinkedIn. (Maybe there's a project there for some of you.)

Arizona Connected Care, is what's known as an "accountable care organization."  It is the only accountable care organization in Southern Arizona, and it's the first markets where UnitedHealthcare is partnering with an ACO.

At least three accountable care organizations are operating in Arizona. Patients do not need to do anything to participate. As long as their care providers are part of Arizona Connected Care, they will see no changes other than more follow-up and attention from providers in the organization.

The article goes on to say that thousands of Southern Arizonans enrolled in UnitedHealthcare "will soon be able to get care through a unique local business that's intended to contain spiraling medical costs by giving patients more attention."  The goal is fewer chronically ill patients and fewer hospital readmissions.

"Monitoring patients after they are discharged can help keep them from falling through the cracks and improve communication between various providers like a hospital, nursing home, physical therapist and rehab center," officials say.

Read more from the article, and check out Arizona Connected Care.