Readers Write

Carrie Vaughan, for HealthLeaders Media, June 25, 2008

It's easy to get caught up in the promise of new technology. I often hear how electronic medical records will save hospitals money and improve efficiency and patient safety. Yet as my colleague Gary Baldwin has reported, EMRs often have a multitude of unanticipated costs and may even be more time-consuming than paper records--at least initially. As this reader points out, I also got caught up in the hype regarding Maryland's new electronic ICU program, Maryland eCare. I should have said that the group strives to improve outcomes and increase access to critical-care physicians, as these goals have yet to be realized.

Tech complacency
Appreciate your article on the eICU collaborative here in Maryland. We are studying how to leverage technology to improve critical care across the University of Maryland Medical System, as well.

I take exception to your lead statement, however: "One example in Maryland shows how a hospital partnership can both improve the quality of patient care and increase access to critical-care physicians through an electronic ICU program." In fact, it remains to be shown if this hospital partnership will improve the quality of patient care. The partners think it will, and have invested in that proposition, but it is premature to state that improved quality is a given. It is the same complacency that accounts for the conventional wisdom that EHRs will pay for themselves by saving money, when in fact such benefits have yet to be widely realized at the physician office level (or at the system level, either). Caring for critically ill patients is a complex endeavor, and current literature abounds with examples of "obviously" beneficial interventions that do not yield measurable improvements in outcomes.

Michael C. Tooke, MD
Senior VP & Chief Medical Officer
Shore Health System

Right care, right now and right there
The partnership between the Maryland hospital systems and Christiana's eCare in Delaware is a monumental step toward joining health forces to bring the intensivist to the patient regardless of state boundaries. The advance real-time technology of eICU is more than placing cameras and securing a contract. Mr. Jim Xinis, Mr. Ed Grogan, and Dr. Marc Zubrow, to name some of the leaders, are building the foundation to improve patient safety and quality of care. Collectively, they have overcome the hurdle of unifying the different boards, leadership, and medical staffs of the independent hospitals to agree on safety first and a sound business plan for the future of Maryland.

IHI and Leapfrog distinguish best practice quality care as the key driver of this model of care delivery. Maryland hospitals, physicians, nurses, and CareFirst initiated and followed through on an ICU collaborative starting two years ago to create standard protocols. The collaborative has created a shared organizational culture giving attention to detail with specific outcome orientation. The leaders have worked with current eICU medical directors, operational directors, physician and corporate sponsors to have both internal and external experts to launch a grounded vision. This will be a success for the patients, families, and the communities served by these hospitals.

Elizabeth Raitz Cowboy, MD
Via Christi Health System

Not unique
I read your article on eICUs with interest. I did want to point out that the Christiana effort is not unique. We currently use the VISICU software through a physician group, Advanced ICU Care, based in St. Louis, MO. We have used their service since January 2006. They provide services to a number of hospitals across the country and I believe even outside the United States. In addition, the University of Wisconsin-Madison is set to go live in the next few months with a service that they are marketing to hospitals in the upper Midwest. The Advanced ICU Care group is particularly interesting in that it is a large private group of intensivists that serve in both the physical and virtual setting.

Larry T Hegland, MD
Chief Medical Officer
Saint Clare's Hospital and The Diagnostic and Treatment Center
Weston, WI

Editor's Note: The reason I found Maryland eCare (not Christiana's in-house eICU program) unique was because it not only links independent facilities together, but also has the backing of CareFirst BlueCross BlueShield in the form of a $3 million grant.

One reader took offense to my assertion that nurses are trained to be clinicians, not managers, in my column, Who's Your Mentor? I agree that more nursing schools are offering some leadership courses on management. Yet one or even two management courses are often not enough training for nurses to enter senior leadership positions, based on what I have heard. So hospitals need to take a more proactive role in training their future nurse leaders.

Art of management
I am a registered nurse and have been for more than 26 years. I graduated from the University of Texas Nursing School in Austin, TX. I have a master's degree in behavioral science psychology. I disagree with your statement, "Nurses aren't trained to be managers. They are trained to be clinicians." Whilst that may be true in many areas of the country, it's not true everywhere, and many BSN programs have management/leadership courses they offer to registered nurses. Many BSN programs require RN students to take a course in management/leadership. Regardless, management isn't a skill exclusive to nursing; it can be learned in other arenas, and many nurses learn management and leadership in those other areas. If one becomes a military nurse, one is trained in the "art" of management. I wasn't in the military but three years, but I learned a lifetime of leadership, delegation, prioritization, and management skills.

I do agree that mentoring is a very important skill for "baby" nurses as well as the more mature nurse to have. Clinician and manager are not mutually exclusive. Nurses "manage" patient care. We "manage" patients and their families. Many of us are in a specialty group called "care managers"; we are the ultimate managers. Please don't neglect to point out another side of the story when making a global-type statement.

Beverly Ann Lynn, MA, BSN, RN

This letter was in response to my column on hospital apology and medical-error disclosure policies:

I'm sorry
Great article you wrote on saying "I'm sorry" for HealthLeaders. Your perspective is precisely why I do not advocate these types of programs. Reputation is demonstrative for hospital and physicians.

We are insurance brokers for hospitals, clinics, physicians, etc. Physicians are extremely reluctant to admit guilt. There is a fine line between guilt and not so guilty, and that fine line should be worked out with the malpractice carrier.

Let us not forget that medical malpractice carriers assume hospital and physician liability for a cost. The cost in consideration (reservation of rights) of liability is an annual premium. Insurance carriers have difficulty with this practice as well.

James Murphy
SeaPort HealthCare

Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at
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