We had previously featured an article on this site on the Smart patient room innovation at the Univ. of Pittsburgh Medical Center. Since, then we have talked to David Sharbaugh(DS), the leader of the smart room project and,  a senior director at UPMC’s center for quality improvement and innovation and, Lucy Thompson(LT) one of the team members.

Today we bring you this exclusive interview.

What is the vision behind the smart room project ?

DS:  We believe this technology will enhance patient safety, allow clinicians to spend more time at the bedside, simplify the jobs of health care workers and improve overall patient satisfaction

Who are the people behind the smart room?

DS: The core development team consisted of 5 people. Working anywhere from part time to full time to complete most of the development. In addition, over the past six months a team of clinicians and medical technologists have worked on this.

Where does the ultrasound technology for Smart Rooms come from ?

DS: the system uses ultrasound tracking devices to identify the numerous caregivers whom a patient might encounter on any given day. UPMC used Sonitor technologies, as the vendor for buying the ultrasound tracking devices.

How much did it cost to build the smart room system?

DS/LT: Since it was internally developed, it mainly cost UPMC man-hours (or FTEs in health care parlance). But,  the total cost to the system would be approximately $2 per patient/day.

What clincal metrics does smart room system impact?

DS/LT: We are currently still compiling the metrics and observing the impact, but it is estimated that this system has reduced the time spent searching for allergies, demographics, since there is a visual cue provided to the care giver on the items that need to be completed. Medication safety is expected to impacted and patient safety, and, fall rate are some other metrics that are expected to improve. Currently, smart rooms are in the medical surgical floor.

How long did it take to train staff on this system?

LT/DS: There was minimal training for this, since the screen interfaces that staff and, physicians need to use are very intuitive.

Future enhancements to the Smart patient rooms system.

The Smart Room went live in early October and is being tested in six patient rooms at the UPMC Shadyside campus .They, told us that they are currently working on releasing the second version. The new version would include code information that will automatically display to the relevant care giver when a code is called.

In addition patient will be able schedule tests, get test results, and other information. Another possible enhancement is informative emails to patients!

We think this is innovative and will keep bringing you more information on future enhancements. So keep watching this space.

Survival of the fittest!

It is very well know that in today’s healthcare business, cash flow is the life blood of any business, specifically in the healthcare industry.

The healthcare industry has become much more competitive over the years. Hospitals proclaiming that they have a state of the art cardiology center, with nurses that put the patient first. I am sure that hospitals across the country put their patients first, it’s just that they do it better, the ad claims.

We see the messages on billboards lining the streets, on TV. from shows like Big Medicine and such. Walk thru a mall and see the ad’s from doctors who are specialist in plastic surgery, weight control, and various other procedures.

One would ask why a doctor, hospital does, emergency service need to advertise, don’t they receive their patients from word of mouth, one doctor recommending another?

One would think so, but the game has changed for ever. In the near future the family doctor will no longer be. We will all be seeing a“specialist” for what ill’s us. You may ask yourself “so what’s wrong with that?” well there is nothing wrong, but if you work in the healthcare industry and run a practice, hospital, emergency care center and such, well you need to make sure that your business has steady cash flow and has a competitive edge, and in today’s world the edge is CASH!

Medicaid and Medicare set the stage for what will be paid on claims. As we know, HMO’s and PPO’s and other insurers follow suit and try to under pay claims as well. You the healthcare provider are providing services on a daily basis and do not receive payment on the claim for 45 to 90 plus days, and that is if it is coded correctly.

The point that I am trying to make is that there is much more competition for each dollar that is out there and a lot of energy is spent to collect that dollar. Separating yourself from you competition is important. Having the steady cash flow for working capital to grow is imperative!

The number one key factor in a provider’s fiscal downfall, or lack of growth, is the lack of working capital. A solution to prevent this lies in the provider’s accounts receivable, an asset often wasting away accumulating dust on the balance sheet that becomes lost revenue due to the time value of money.

Many “C-Suite” healthcare executives are choosing medical accounts receivable (MAR) funding as an important tool in their business financing strategies. MAR funding’s flexibility and immediate cash infusion reduces their dependency on debt-incurring bank loans and lines of credit as their sole forms of financing. It provides a predictable and steady cash stream and the amount of medical accounts receivable funding is not limited by a bank’s often under-valued assessment of the provider’s assets

Bank credit lines are often insufficient to meet a provider’s working capital needs and monthly cash flow plans, especially when a conventional bank determines a line based on a significantly “under-valued” valuation of the provider’s assets. Additionally, the bank may be quick to disqualify that collateral once the aging reaches 90 days. This often happens because most conventional banks do not have the deep understanding and working knowledge of the healthcare business, its industry specific regulatory requirements and cash flow challenges.

I challenge you to take a look and see if your business can survive?
How “fit” is your business?
Who are your competitors?
Do you have cash on hand to handle the ups and downs or to expand your business, to be competitive?

Editor’s Note: James Hill is the author of this article and, Vice President at Choice Med Consulting. He can be reached at medicalcash@yahoo.com , you can also check out his profile on linkedin

Emergency Room incident at King’s County hospital

The King’s county hospital in Brooklyn, N.Y. has several claims to fame; It was the site of the first open-heart surgery performed in New York State; Kings County physicians invented the world’s first hemodialysis machine, conducted the first studies of HIV infection in women and produced the first human images using magnetic resonance imaging (MRI). In addition, Kings County was named the first Level 1 Trauma Center in the U.S.

It is ironic then, that the hospital became the center of all media attention for a negligence death in their waiting area in the Emergency Room. Esmin Green, a 49 yr old psychiatric patient had been waiting in the emergency room for more than 24 hours before she toppled from her chair and fell on ground. Although the waiting room was occupied by other patients, a security guard, and a staff member, no one cared to help Green until more than an hour after her fall (Check out the Associated Press report for further details on this).

Isolated incident or alarming trend?

HealthCare Management decided to do some research of our own and here is what we came up with.

• An archived article in New York times talks about Federal regulators reprimanding cook county for serious flaws in how it decides who should receive emergency care and for treatment delay
• The king’s county hospital’s emergency room sees about 116,000 patients a year
• In 2007, Kings County hospital deployed, MediKiosk software solution, that automates patient registration and helps emergency department staff prioritize treatment based on medical urgency
• According to a recent survey conducted by the American College of Emergency Physicians (ACEP), 80% of the 328 emergency departments surveyed board psychiatric patients
• 30% of ACEP surey respondents said they board patients between 8 and 24 hours

Before, we conclude it is a dead end, let us look at some other facts that might present solutions

• 85% of the doctors in the ACEP survey said that wait times for all emergency patients would improve if there were better psychiatric services available.
• More than 80 % agreed that regional dedicated emergency psychiatric facilities nationwide would work better than the current system for dealing with psychiatric emergency patients.

Maybe, it is time to redesign the Emergency care ? We rest our case, now you decide!

In a previous post we talked about electronic health records, and how hospitals and providers are embracing it to improve patient safety. With the introduction of the new iPhone3G, electronic health records are now going beyond the computer and into the iPhones. Hand held devices are always popular with physicians (tablet pcs and pdas). Now, consumers and providers can access health records on their phones.

Some current applications available at the online apple store

Medfile - Developed by Kaplan design lets users create and manage their personal medical records. Information such as blood type, allergies and emergency contact etc can be stored and retrieved.

ADAM - An application that lets the users identify health symptoms.From a simple sprain to fever, and upset stomact, ADAM gives users access to up-to-date medical information that is expert-reviewed. The tool also provides information on what the symptoms mean and when to seek professional medical attention.

These applications are fairly new, and are surely going to generate debate amongst medical professionals within and outside the blogosphere. Also, it remains to be seen, how popular these applications get with consumers.

We at HealthCare Management will keep a tab on this. So keep watching this space.

There has been a lot of activity in the Health 2.0 world recently. There are already two major Health 2.0 related conferences. Atleast a dozen new health 2.0 applications in the first half of this year and the launch of Google Health and Microsoft Health Vault. As usual, we at Healthcare Management will help you keep upto date with what is going on. But like with our previous articles, we intend do our research before we publish. Soon we will be talking with Google Health development team and folks at Aetna to get an understanding of what their Health 2.0 plans are. But before, we get too far ahead let us examine the basics.

What is Health 2.0 ?

Health 2.0 aka Medicine 2.0 aka eHealth, can be broadly defined as ” applications, services and tools are Web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers, that use Web 2.0 technologies as well as semantic web and virtual reality tools, to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups.

The idea is simple. Health 2.0 is about interactive Web services,that, will arm individuals with information, tools and supportive online communities so they can take charge of their own medical care — and in turn transform the U.S. and other healthcare systems by demanding better service and lowering costs.

Watch this space in the future as we profile some emerging health 2.0 applications and services.

Star Trek at Bedside

Imagine a hospital room, which recognizes doctors and nurses as they enter. Their name flashes on a flat panel screen for the patient and family to see. At the same time, a second monitor, shows the clinician exactly what they need to know at that moment to care for the patient. Information displayed includes: medication due, patient’s vital signs, and allergies. Does this sound like futuristic technology too good to be true? Well, it is not.

The smart room idea has already been developed and tested at the University of Pittsburgh Medical Center(UPMC). They have been testing this since early October at their Shadyside campus. The idea for the Smart Room came about two years ago when a UPMC nurse wearing latex gloves unknowingly went to place an IV in a patient with a latex allergy, causing an allergic reaction

Effective Technology

According to the UPMC , the system uses ultrasound tracking to identify the clinicians that might come to advance the care process for a patient. Each worker is assigned a unique tag—smaller than a pager—that emits ultrasonic sound waves, when the person wearing the tag first enters the Smart Room. The ultrasound detector in the room reads the tag and identifies the caregiver by name and job title, displaying the information on a flat-screen monitor at the foot of the patient’s bed. When a caregiver leaves the room, the information disappears from the screen. In this pilot phase, tags have been assigned to doctors, nurses, nursing assistants, phlebotomists and dietary hosts and hostesses.

Benefits

The biggest benefit of this innovation is in helping improve patient safety. Patient identification is a key factor in the care process and numerous errors can result from not verifying patient id. Smart rooms can help minimize that. In addition medication errors can be greatly reduced. Less obvious benefits can include, improving workflow and minimizing redundancy. The amount of time wasted in communication between care givers to gather information can also be impacted with this system.

**Picture courtesy UPMC media kit

Increasingly, healthcare organizations are investing in clinical information systems. According Kalorama Information – the publishing division of MarketResearch.com, hospitals in the United States would be spending close to $4.8 billion on Electronic health record(EHR) or Electronic medical record systems(EMR). Despite the brouhaha, there is a lack of understanding of what an EHR can do and can not do.In this post, we will attempt to peal the layers.

What is an EHR/EMR?  Simply put, the EHR  is an electronic record of a patient’s medical history. This electronic record includes important information like test and imaging results, medication history, Emergency department visit summaries, doctors’ notes and general health history – from childhood allergies to surgeries.

All of this exisits currently, (in most hospitals).But, in paper charts and in some cases in databases behind applications that do not talk to each other . For Instance, the Emergency department diagnosis, might reside in EMSTAT(a popular ED application) , while the same patient’s Inpatient treatment notes resides in another application such as Affinity. 

An EHR ultimately replaces the paper chart currently used to store the same information. The electronic version of the record can be made available to the patient’s caregivers in different locations, more quickly and efficiently. And when done well, it minimizes data redundancy (the need to enter the same information over and over) . So for instance, information captured during an emergency visit can be retrieved by an inpatient care giver, if the patient goes on to recieve care as an inpatient. 

How does EHR help hospitals ?

The EHR can help hospitals and health systems make improvements in three major areas.

1. Improved quality of medical decision making

It provides doctors with immediate access to a patient’s health information.Whether it is an Emergency Physicain, or a nurse that needs to phone an on-call physician in the middle of the night, the patient’s chart can be accessed to support important treatment decisions. In addition, in most cases the EHR is connected to a robust library of medical information that can help physicians in making diagnoses and treatment plans based on the latest research.In some cases, it can generate automatic reminders by mail or e-mail to notify test result availbility, critical values and other useful medical information.

2. Improved Patient Safety

Because doctors’ orders and prescriptions are entered into a computer rather than in handwritten orders, pharmacists and other caregivers have no trouble interpreting the information. This greatly reduces the possibility of transcription errors and other medical mistakes. Thereby reducing adverse drug events and increasing patient safety.

3. Improved efficiency

Caregivers will no longer need to search or wait for your patient chart. In addition, lab results and X-rays can be sent electronically to your doctors as soon as they are completed, for immediate analysis, diagnosis and treatment.

In addition to the major areas listed above, there are other advantages including cost savings from an EHR implementation.  In a recent article that  Houston Neal, (Director, Business Development, SoftwareAdvice.com) shared with us, they talk about how EMR can help reduce medical malpractice insurance premiums, reduced downcoding and even revenue gains by participating in pay for performance time programs (Medicare Care Management Performance (MCMP) ).

Volume trends in US healthcare - Shift from hospital to non-hospital settings

Over the past five years, hospital inpatient and outpatient admissions are growing at a much smaller rate than non-hospital based outpatient services. A clear case in the point being outpatient surgeries. Increasingly, outpatient surgeries are moving to non-hospital based settings, taking with them the observation, follow-up and possibly some Med surg volumes (see below)

Competition for Market share

The current payment system is also fuelling this trend, as it gives non-hospital providers an advantage in that they are able to focus on most profitable services (such as opthamalogy). While, hospitals face a higher cost structure to support unprofitable but essential services (such as inpatient psychiatric units). In metro areas like Houston, for instance small, ful service facilities are springing up as a result of joint ventures between physicians and Wall street based venture capital funds.

This means now more than ever, traditional hospitals need to have strategies in place to fight for market share with these free standing centers.

5 Strategies for maintaining and growing volume

1. Increase outpatient services capabilities to compete on equal footing with freestanding ASCs

2. Consolidate core programs to better withstand market competition - Build strong programs in profitable areas such as thoracic surgery, ENT and Oncology

3. Integrate physicians into strategic planning, management and governance - A close analysis of the freestanding ASC type centers reveals over 60% of these facilities are developed by physicians or physicians in conjunction with another entity.

4. Build in Quality and increase it’s visibility - Do what Toyota did in the auto industry. Drive process and quality improvement and build your hospital brand around these initiatives and outcomes (Eg: Lowest infection rates in the city).

5. Invest in and utilize Business intelligence - To stay ahead of the curve you need to know, where you are in relation to your competition so continuously and rigorously measure and feedback business intelligence to your managers and administrators

An earlier article on this blog talked about physician rankings. In this post let’s look at hospital rankings.

America’s best hospitals

There are various agencies and organizations that rank, index and grade american hospitals. Some of the well know ones are US News, Thomson Healthcare (top 100) and more recenlty web 2.0 sites like HealthGrades. The idea behind these rankings is to provide consumers a guide map to choosing hospitals.

Methodology

Methodology that these publications and agencies use range from internally developed surveys to benchmarking databases and others use information that is collected and published by United States Department of Health and Human Services. US news ranks by specialty as their goal is to identify facilities that excel at treating variety of illnesses within a specialty, as opposed to just few procedures. US News uses data from the American Hospital Association survey of its members.

Web 2.0 application - Finding a hospital near you

Recently we came across a web based application that lets you search for hospitals in your neighborhood (by zip code) and tells you how good the hospitals perform on a variety of process measures that the hospital compare database (Department of Health and Human services)tracks. The best hospitals have green stop lights and the worst has red. We tried this on Washington DC area hospitals and here is what we came up with. Check it out for yourself.

The benefits of improving patient flow go way beyond reducing wait times. While most healthcare administrators tend to focus on reduced diversions (in the ED), elopments, elective surgery cancellations, improving flow can positively impact quality of worklife for physicians, nurses and staff . This can in turn have a very positive impact on patient satisfaction and quality of care.

Here are top 5 tried and tested strategies used to improve flow.

1. Evaluate and monitor bed status in Med surg and Intermediate care units continuously - Don’t sweat the small stuff, the biggest bottleneck for patient flow is mainly in these units. In any acute care hospital, when you hear ‘we don’t have beds’ that usually means there are no monitored beds. So focussing on these units instead of the rest of the house helps. Also, these are the units where there are lots of activity during the day (usually not captured in midnight census which is used to measure occupancy usually). Increasing bed capacity in these units will help flow greatly.

2. Minimize transfers: Again this is counter intuitive but if you actually observe data you will see that transfer consume the most resources (beds, staff, environmental services etc). So do it right the first time and put patients in the right level of care. This can also reduce your insurance denials and impact finances positively.

3. Create an admissions unit to reduce stress on your ED: If your diversion hours in the Emergency Department and admission times are hitting the roof, you know you are in crisis. For quick relief create and admissions unit to keep the ED rooms/beds turning over quicker than usual. The admissions unit can focus on tracking and expedite flow to different units while the ED focuses on providing emergency care and evaluation.

4. Create a discharge lounge : Add a checkout lounge with a coffee bar and flat panel tvs to move patients waiting for a ride, so the valuable beds can be turned over to accomodate other patients. This will also impact patient satisfaction positively.

5. Airlines style surge staffing with demand: Use the airline model when it comes to staffing. Airlines tend to staff proactively during peak hours (and don’t worry about productivity in the short run).Also rememeber this does not only mean nursing staff. This applies to support staff as well. If you don’t have adequate environmental services staff for instance, there is not chance of beds opening up quickly on discharge. Moreover, support staff don’t cost much but are an asset in opening up beds.