National Coordinator for Health Information Technology Farzad Mostashari, MD, spoke with Healthcare IT News Senior Editor Diana Manos Monday at the HIMSS Media ICD-10 Forum in National Harbor, Md. With his typical candor and energy, Mostashari commented on several healthcare IT issues and about ICD-10 – the focus of the forum and the topic of the keynote talk he had delivered earlier in the day. Yes, he was wearing his signature bow tie. Q. How did you get so passionate about healthcare IT? A. I went to the school of public health first, thinking I was going to help populations and do international work, and then my Dad got sick.
With Vermont leading the way, five of New England's six states rank in the top six for primary care doctors per capita, according to data from the Association of American Medical Colleges. The sixth, Connecticut, ranks 12th. As the national shortage of primary care doctors expected to increase after the federal Affordable Care Act takes full effect next year, some are looking to New England's states with an eye to what they've been doing right. Several factors contribute to New England's relatively strong position. Among them: strong public health programs ensuring that high percentages of residents have health coverage, meaning fewer doctors deliver uncompensated care.
Taking advantage of recent advances in nanotechnology and microfluidics, researchers have made significant progress toward a device that could be used to rapidly remove pathogens from the blood of patients with sepsis, a potentially life-threatening condition that occurs when an infection is distributed throughout the body via the bloodstream. The new system effectively acts as an artificial spleen, filtering the blood using injectable magnetic nanobeads engineered to stick to microörganisms and toxins. After the beads are injected, blood is removed and run through a device that uses a magnetic-field gradient to extract the nanobead-bound germs. Then the blood is returned to the body.
The importance of sleep is perhaps most realized when we become sick. When we are hospitalized and most in need of every ounce of health, though, hospital care practically guarantees that we won't get good sleep. Fortunately, two approaches hold promise to improve sleep for patients: one organizational, and the other a common trick of the trade among those of us working in behavioral economics. Recently I was all-too-miserably reminded of the challenges of hospital sleep when I spent a fitful night recovering from surgery to remove a small kidney tumor. Unlike some patients in that situation, my sleep was not disturbed by pain or nausea; I was lucky to avoid both of those postoperative complications.
Fourteen years have passed since the Institute of Medicine released its seminal report,To Err Is Human: Building a Safer Health System. Almost overnight, an intense scrutiny occurred in U.S. hospitals with a focus on measurements of clinical quality and patient safety. That the IOM message was taken to heart clearly can be seen in the results of the HealthLeaders Media 2013 Clinical Quality andPatient Safety Survey.
The commitment to performance metrics, organizational accountability, and diverse resources comes through in the survey results. Great progress has been made to ensure that things are done right (quality) and that the right things are done (safety). But as also is seen, challenges for the future remain.
William K. Cors, MD, MMM, FACPE
Vice President and Chief Medical Quality Officer Pocono Health System East Stroudsburg, Pa.
When looking at the present state, the survey findings correlate tightly whether the question posed addressed "clinical quality" or "patient safety." For example, when asked about experience with metrics, the survey showed 95% of reporting organizations indicating either a "great deal of experience" or "some experience" with both clinical quality metrics (Figure 5) and patient safety metrics (Figure 6).
Likewise, the importance of these initiatives in organizations is demonstrated by the "highest level of leadership" to be at or above the vice president level in 83% of organizations for clinical quality (Figure 1) and 76% for safety initiatives (Figure 2).
A further parallel showed that 79% of organizations surveyed felt that the level of resources committed to clinical quality was "exceptional" or "adequate"; for patient safety it was 80% (Figures 11 and 12). The survey indicates that most organizations have taken seriously the IOM's call to arms.
When addressing the future, greater divergence of opinion emerges. When asked to cite their organization's biggest challenges in Hospital Compare clinical quality metrics (Figure 14), 68% of respondents identified 30-day readmission rates as the No. 1 concern.
The other closely associated value-based purchasing "outcome metrics" include serious complications and mortality and yet few respondents list these concerns among their top three: just 22% and 11%, respectively. Why such a disparity? Readmissions may represent the angst of a provider having to bear financial risk for a whole spectrum of care that they may not control. For some, this may include patient behavior/preferences, and an entire host of postacute care options that may not be well integrated.
A further disparity is noted when leaders were asked to address the three biggest challenges in advancing to the next level of quality (Figure 15). Integrating clinical data with IT is the only item registering above 50%. Below that is a smattering of different concerns, such as limited personnel or financial resources.
Similar scatter is noted when healthcare executives identified the three biggest stumbling blocks to adopting an effective safety program (Figure 17), where the highest score was 35% for fear of punishment for self-reporting errors and fear of retaliation for reporting others' errors. Additional roadblocks included concerns about leadership, communication, and buy-in.
So, while great progress has been made since the 1999 IOM report, there also is a long road yet to go. Future challenges include both external and internal concerns. The external concern is the need to integrate care in order to provide clinical quality and patient safety across an entire continuum of care settings.
The internal challenges concern culture, that stew of behaviors, beliefs, and actions that define an organization. Concerns about fear and retaliation and communication and leadership clearly are identified. The challenge for leaders is to drive the changes necessary to align external forces and address internal culture to achieve the next level in both clinical quality and patient safety.
At a Capitol Hill hearing Tuesday, journalist Steven Brill, who examined the issue of the high cost of health care in a much quoted March 2013 Time magazine article, told Senate Finance Committee members that President Barack Obama's health care law will do very little to lower prices for consumers. Joined by a panel of health policy experts at the hearing to explore ways to make health pricing more transparent, Brill said that while he views efforts to disseminate prices for health services to consumers favorably, he believes that increasing transparency has its limits. "[Transparency] starts the conversation about prices that we didn't have in the debate over Obamacare. It's only a start," Brill said.