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.

 Let us examine some interesting facts on healthcare spending.

U.S. Health Care Spending to Double by 2017

According to a recent report published in the online edition of Health Affairs,U.S. healthcare spending is projected to reach $4.3 trillion. This equates to approximately one fifth (or 19.5%) of the gross domestic product(GDP).Hospital spending is expected to increase and gradually slow down through 2017, going from $696.7 billion in 2007 to more than $1.3 trillion in 2017. Prescription drug spending is expected to slow down initially and then start to accelerate through 2017. Drug spending will increase from $231.3 billion in 2007 to $515.7 billion in 2017.

Healthcare spending to double in India by 2012

For an emerging economy, India spends a small $14.8 billion on healthcare which equates to roughly 5.2% of the GDP. This will however change quickly and the country is expected to spend $33.6 billion by 2012 with healthcare spending accounting for 8.5% of the economy.

Here is a graph comparing spending for some countries as a % of their GDP of their  stack up currently (Source: WHO Health Statistics,2007).

Video update!!!

British Healthcare system
The  National Health System(NHS) is the publicly funded healthcare system in the UK. The NHS provides the majority of healthcare in England, including primary care (such as general practitioners), in-patient care and long-term healthcare. NHS hospitals are increasingly competing with other private health systems and facing financial difficulties.

Lean applied in Birmingham Heartlands hospital

Recently, the NHS health system and other health systems have adopted ‘lean principles’ that evovled from the Toyota production system to reduce waste. They are primarily focussing on clinical areas such as emergency departments but plan to use it ancillary areas, pharamcy and other support functions.
They have also come up with innovative solutions such as using Nurse practicioners in the ED to treat low acuity patients . They have been able to reduce the number of patients waiting from over 40 to less than 10. 

Emerging trends in healthcare: Physician Ranking systems

A previous post, on this site briefly touched on ‘Zagat survey style’(for those not familiar, the Zagat survey rates restuarants in the US and around the world) physician ranking systems making their presence felt in the websphere. Believe it or not, this is not a flash in the pan. Infact, there are several establish sites that already rank physicians. Some others are extending this to hospitals, but more on that later.For this post we will stick to physicians and providers.

N.Y. leads the way

Late last year, New York’s attorney general  Andrew Cuomo announced  a first-of-its-kind agreement with Cigna Corp. The plan is to establish an industry standard for the doctor-rating systems that health insurers increasingly use to guide consumers. While health plans and insurers have been doing this for years, public will now have access to how health plans measure and rate doctors in terms of quality of care and cost efficiency.   

Sounds fair and square? So what is the caveat? If you are a health professional you will probably identify right away that there is a possibility that this might eventually steer patients to the cheapest, rather than the best doctors and services. UnitedHealth, for instance, gives doctors and hospitals that follow certain care guidelines and are cost-efficient a “UnitedHealth Premium” designation.

Quality or Cost ?

Jim Collins in his best selling book ‘Good to Great’ says that Good is the enemy of Great.  However the same logic can not be applied here. Meaning, “Quality is not the enemy of cost”. If you are not convinced all you have to do is look at other industries. In the auto industry for instance, they have realized that at some point there is a tradeoff between quality and cost and so good quality at a reasonable cost has become widely accepted. Quality guru, Walter Massing  states that the only viable policy is to concentrate on failure costs and to justify prevention measures for one problem at a time. 

What consumers need to know and health 2.0 sites need to publish?

So where does all this lead? Healthcare providers have a stake in this and so they will need to brace themselves, start looking at quality of care and efficiency a little more seriously. The serious Health 2.0 sites need to start publishing performance / rating on a host of information besides bedside manners and pleasantness of physician (which are important, but do not provide any insight to the physician’s chances of success in the treatment process). 

Here is a sample list of indicators that we need to look at to determine the best doctors/providers for our friends and family.

• Customer satisfaction metrics:Bedside manners
• Process metrics: Average wait times
• Clinical quality and outcomes: Hospitalization rate and risk-adjust mortality
• Other measures: Clinically integrated IT systems (known to influence medication and surgery risks)

TGIF!! to all our loyal readers. We are happy to unveil our new presentation and cool new features.

Why we changed our site presentation? 

As you can see we have changed our site layout design. The motivation behind this is to provide better readability and user friendly interface. Also, we picked this design after exhaustively researching usability of several hundred designs. As our site and community grows, we would like to provide many more exciting features and this site is better suited for that.

What is new ? 

1. Registration: Readers can now register by simply clicking the register link under Meta. This is particularly useful for users who would like to contribute articles, ideas and tools on a regular basis

2. Search: We don’t need to explain that to the googler’s of the world do we ?

3. Entries RSS and widgets to embed in your site: You can now subsribe to this site via a host of reader services such as google reader, news gator, netvibes etc.

You can also embed entries on this site as a widget on your personal site or social network page!!. Just click on entries rss for this.

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