The chairwoman of the board that oversees Parkland Memorial Hospital said Tuesday that she remains hopeful the facility will retain its ability to receive government healthcare reimbursements, but she offered no assurances. The Dallas County hospital's Board of Managers met in executive session Tuesday evening for a briefing about a follow-up inspection by the Centers for Medicare & Medicaid Services. No official action was taken. "I'm hoping and I'm optimistic that (Parkland will pass the re-inspection)," Lauren McDonald, MD, chairwoman of the Parkland Board of Managers, said after the two-hour closed-door session. "But I'm not putting all my eggs in one basket." Jay Shannon, MD, CMO, said hospital administrators expect a report from CMS by Sept. 15. The hospital's Medicare and Medicaid funding could be cut off effective Sept. 30 if the hospital has not remedied problems found in an earlier inspection.
With healthcare providers working to implement electronic health records to qualify for meaningful use incentive payments and vendors seeing big spikes in business, it is not surprising that there is a huge demand for health IT professionals. What is surprising, though, are reports from recent graduates of federal health IT training programs who say they can't find a job. It's been estimated that the country will need up to 50,000 health IT professionals to help doctors and hospitals meet meaningful use criteria. With the U.S. unemployment rate hovering around 9%, health IT is seen as an area ripe for job creation. The federal government has invested millions of dollars in developing a skilled health IT workforce, and interest in federal health IT training programs has been high. The first graduates of the health IT training programs hit the job market this spring, but the jury is still out on the success of their success. Federal officials have touted the training efforts as a significant step in the right direction, while some graduates say they are frustrated by the lack of career opportunities.
Like other natural disasters before it, Hurricane Irene disrupted hospital services in the Northeast, causing hospital IT officials to once again mull their disaster preparedness strategies. Several recent reports in the aftermath of Irene show how damaging hurricanes can be to hospital systems. At Johnson Memorial Medical Center in Stafford Springs, CT, 43 patients were relocated to other medical facilities when the hospital lost power and utility workers were prevented from fixing the problem because of the approaching storm. At Staten Island University Hospital in New York City, reports surfaced that the hospital's IT department shut down its computer network, all applications, and phone systems. The hospital suffered minor damage. However, their information systems returned to full operations and, shortly after that, the facility was open for business due, in part, to what CIO Kathy Kania described as a business continuity plan that works. Reports like these have led Pam Matthews, senior director of regional affairs at the Healthcare Information and Management Systems Society to contemplate what happens to data when patients are transferred to other medical facilities.
In a New York City program that subsidized doctors' electronic health records in return for sharing quality data with the city, physicians showed significant improvements on eight of 10 preventive care indicators, according to a new study in the Journal of the American Medical Informatics Association. The findings provide some perspectives on the federal government's Meaningful Use program, which requires attestation-of-quality data this year and electronic reporting in 2012. Not coincidently, the national coordinator of health IT, Farzad Mostashari, MD, who has responsibility for implementing the federal incentive program, led the team that created the New York EHR program when he was assistant commissioner of the city's department of health and mental hygiene. Since 2007, the Primary Care Improvement Project has helped primary care doctors in underserved areas acquire EHRs. Quality data has been transmitted automatically from those EHRs to the department of health on a monthly basis. The JAMIA study focused on 309 small practices that adopted EHRs under PCIP between 2007 and 2010. Most of these practices contained only one or two physicians, and 53% of their patients were on Medicaid or uninsured.
There are several factors inhibiting EMR adoption, but the concept of usability is often at the root, and rightfully so. Although effective training and implementation methods affect user adoption rates as well, poor usability has a strong impact on productivity, error rate, and user satisfaction. And usability should be considered more than just user satisfaction, according to Rosemarie Nelson, principal of the MGMA Consulting Group. The concept is far more complex, and to Nelson, it's synonymous with workflow integration. "Too much attention is given to the number of clicks and screens, when what should be considered is how and when information is presented," she said. Steve Waldren, MD, Director of the American Academy of Family Physicians' Center for Health IT, explained that when it comes to understanding usability, it's essential to consider utility as well. "Usability is subjective in many ways," he said. "It has to do with the functionality of the system. Utility is making sure the system does the things you need it to do."
With a sharp decrease in psychiatric beds and with mental health staffs spread thin across California, emergency rooms increasingly have become costly and ineffective baby-sitting services for mentally disturbed patients in crisis. The economic downturn and budget cuts are exacerbating a chronic problem, creating added safety risks at hospitals and placing a burden on already crowded emergency rooms. Meanwhile, hospitals are increasingly facing a dilemma: They can't find proper facilities to care for the patients yet can't release them to the streets. "We are inundated with these patients," said Marc Futernick, California Hospital's director of emergency services. "The design of the system is that everyone gets taken care of in a timely fashion. The system is broken." That breakdown can be costly. Hospitals get stuck caring for uninsured psychiatric patients; the public has fewer emergency room beds available; and the mentally ill often do not get the therapy and medication they need.