In a perfect world, everyone in the world would have access to vaccinations against influenza and administration of flu vaccinations would be safe, simple, and effective. We do not, of course, live in a perfect world. But two new technologies are getting medicine a little closer to those goals.
The traditional vaccination method—using a needle and syringe—can be difficult, time-consuming, and dangerous in some countries where unsterile reuse occurs. So why not eliminate the needles? Needle-free jet injectors (and yes, they look like the hypospray devices from the Star Trek TV series) can administer tens of millions of doses of influenza, smallpox, meningitis, and many other vaccines in rapid fashion. Jet injectors reduce the dangers of needles, including reuse of non-sterile needles, needle-stick injuries to health workers, and unsafe disposal of sharps waste, according to the CDC.
Another benefit to the devices: When flu vaccine is given between the layers of the skin, a reduced dose of vaccine can often be as effective as a full dose. This might allow more people to be protected when specific vaccines are expensive or scarce.
Access is another barrier to getting the world vaccinated. There simply aren’t enough healthcare workers to administer vaccines worldwide—regardless of whether they’re using a jet injector or needle and syringe.
Microneedle skin patches—small devices that are easy to distribute and easy for laypersons to use—might solve that problem. The patches contain an array of stainless steel microneedles coated with inactivated influenza virus. The patches are pressed into the skin and, after a few minutes, the vaccine coating dissolves within the skin. Researchers say the patches are just as effective at protecting against influenza as conventional hypodermic immunizations.
They are also small and relatively inexpensive to produce, which helps with wide distribution, such as to underserved areas or developing countries. And they're easy to use. Unlike conventional hypodermic injections, microneedles are prepared in a patch for simple administration, possibly by patients themselves, and applied painlessly to the skin without specialized training.
Researchers are also working on a tiny and simple pump that contains a liquid that boils at body temperature—it is activated by the heat from the touch of a finger. The heat causes the liquid to turn to a vapor, exerting enough pressure to force drugs through the microneedles in the patch.
And here’s a bonus: Neither method hurts as much as the traditional ones.
Read more about the work researchers are doing on microneedle skin patches---as well as possible future uses for the devices, in the December issue of HealthLeaders Magazine.
Technology to help diabetics manage their disease—such as the artificial pancreas or mobile phone apps that help monitor glucose readings—might make a difference on an individual level, but the real key to tackling the disease is by making diabetes care more coordinated and patient-centered. The technology that will make a difference in that area is more familiar and less flashy: electronic health records, telemedicine, and basic information networks for sharing and collecting data.
Smart devices that can send glucose data to an information network will only be effective when there is an established and interconnected network for them to talk to, writes Elyas Bakhtiari in the December issue of HealthLeaders magazine. And although the healthcare industry hasn't yet built that base, hospitals and health systems are increasingly making it a priority.
The government is making it a priority, too—and putting money behind the effort. Of the that the Department of Health and Human Services awarded $220 million in grants through its Beacon Community Program is for piloting health information technology programs—the bulk of which is being used either directly or indirectly to improve diabetes care. The networks aren't easy to build, but there is a potential for significant return on investment if the government, providers, and payers share the burden.
Patient-centered, interconnected care is good thing for all healthcare and especially for the most troublesome disease states. Diabetes is an ideal starting point for building the IT backbone because of its prevalence and the improvement potential of data sharing, John Hennessey, director of patient management systems for Kaleida Health, a five-hospital system based in Buffalo, NY, tells HealthLeaders Media. "I think from an IT perspective, having the infrastructure to share information is really the impetus."
One of the primary benefits of a robust HIT network is better communication—with both patients and other providers, says Smita Bakhai, MD, medical director for the outpatient internal medicine clinic at Erie County Medical Center in Buffalo, NY.
Free-flowing information allows physicians to better track the slew of referrals to specialists and various tests required for a typical diabetic patient over a lifetime. It also makes it easier to follow up with a patient after a discharge or diagnosis, monitor the disease over time, improve patient self-management, and even jump on early detection. The result, hopefully, is reduced readmission rates and ED visits from heart attack, stroke, and other complications of diabetes.
Read more about how these and other organizations are using technology and sharing health information data to improve diabetes care in Data-Driven Diabetes Care Gets Smarter.
Blumenthal isn't very well known outside of the healthcare industry. But among healthcare providers—especially IT leaders—he's kind of a rock star. When he speaks at healthcare conferences (he is a popular keynote choice) attendees line up afterward to have photos taken with him. [Read more]
Watchdog organizations don't always have the best relationships with those they are watching. When asked to describe her relationship with healthcare providers and leaders, Leah Binder, CEO of The Leapfrog Group, deadpans the answer. "Some of my best friends are in hospitals," she says. She pauses and then laughs. "I promise," she says. "Some of them don't like me but I will tell you that some of them do."[Read more]
There are a number of individuals and organizations pushing to improve healthcare quality through the use of technology and other methods. The Leapfrog Group is one such organization—a consortium of healthcare purchasers that uses survey data and public reporting on quality measures to help consumers and employers compare hospitals' safety, quality, and efficiency. It has also called for better utilization of clinical technology such as EHRs and computerized physician order entry.
This year, HealthLeaders Media named Leapfrog's CEO, Leah Binder, as one of the 20 people who are making healthcare better. In last week's column I wrote about another person on the list who ties technology to quality improvement: David Blumenthal, MD, the national coordinator for health information technology.
Both are trying to improve healthcare quality through technology, but they have something else in common, too. They take the position that it can't be done by wagging fingers and issuing edicts. They say that change will only come when the industry as a whole—including providers, patients, family members, the government, and watchdog groups like Leapfrog—work together.
Blumenthal has put an emphasis on input and collaboration—he works with industry trade groups and state and federal offices. He's enlisted thought leaders, formed committees of experts, and sought input from patient privacy and legal rights advocates. He's called on healthcare leaders to be participants and partners in determining the future of electronic health systems.
"We envision a future where information follows patients," he says. "Unconstrained by competitive rivalry, unconstrained by geographic boundaries, unconstrained by cultural disinclinations to collaborate, we want teams to emerge in local communities that make exchange possible. And we will be using the meaningful use framework and all other levers at our disposal to try to make that possible."
Binder, too, talks about the role that these different groups have to play in making healthcare better. "Community members, leaders, parents, and grandparents are coming together and walking into hospitals and sitting down with doctors and CEOs and saying, 'What are you going to do to improve things?' And it's really impressive. It's a change and a new way of thinking about how we all contribute to improving healthcare," she says.
I like the idea of quality improvement as a big tent, with lots of different people underneath it using lots of different methods and technologies to make healthcare better. Including Blumenthal and Binder on this year's list has allowed us to expand it exponentially—in fact, there's room in the tent for anyone who's reading this column.
Each year the editors at HealthLeaders magazine choose 20 people who are making healthcare better. One of my nominees this year was David Blumenthal, MD, the national coordinator for health information technology. I called him "kind of a rock star" among healthcare tech types—I wonder how this buttoned-down doc will react to that characterization. And I wonder, too, how the healthcare industry in general will react to the idea that we think he is one of the 20 people who are playing a crucial role in the betterment of healthcare.
I'm guessing that opinions either way would be not so much a referendum on Blumenthal personally but on electronic health records systems in general.
Standards and certification, financing, technology, logistics, privacy and security, software and hardware, and their overall ability to improve quality of care—there are still a lot of unanswered questions about the feasibility and efficacy of the systems.
How will competitors share health data without compromising the health of their own organizations? How can organizations afford to gamble their own time and money in electronic systems before the stimulus dollars start to flow? How do small physician practices navigate such a complex path to IT? How do they know if they're choosing the right system? And what, exactly, will "meaningful use" mean in future stages of the effort?
Blumenthal has put an emphasis on input and collaboration—backed by regulation in the form of the HITECH Act and some $20 billion in government incentives for those organizations that become meaningful users of HIT. He works with industry trade groups and state and federal offices. He's enlisted thought leaders, formed committees of experts, and sought input from patient privacy and legal rights advocates. He's called on healthcare leaders to be participants and partners in determining the future of electronic health systems.
Blumenthal has, he says, "a great deal of confidence" that healthcare leaders can—and must—achieve widespread meaningful use of the systems. "But I've also learned from them that this is tough," he says. "There's no lack of work to be done."
Whatever you think about our decision to add him to our list of 20, it's hard to imagine that all of that work won't pay off.
"Community members, leaders, parents, and grandparents are coming together and walking into hospitals and sitting down with doctors and CEOs and saying, 'What are you going to do to improve things?'"
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Leah Binder's story.
Watchdog organizations don't always have the best relationships with those they are watching. When asked to describe her relationship with healthcare providers and leaders, Leah Binder, CEO of The Leapfrog Group, deadpans the answer. "Some of my best friends are in hospitals," she says. She pauses and then laughs. "I promise," she says. "Some of them don't like me but I will tell you that some of them do."
The Leapfrog Group, a consortium of healthcare purchasers, uses survey data and public reporting on quality measures such as central line infection rates to help consumers and employers compare hospitals' safety, quality, and efficiency. It also recognizes and rewards hospitals that take steps to reduce preventable medical errors and that meet its tough standards for adoption of quality improvement tools such as computerized physician order entry.
In a Leapfrog study earlier this fall, 214 hospitals used a Web-based simulator to see if their CPOE systems would catch common medication errors, including potentially fatal errors. The CPOE systems on average missed half of the routine medication errors and a third of the potentially fatal errors. Leapfrog also found that nearly all of the 102 hospitals that repeated the test improved in one or more medication categories. Leapfrog has issued testing guidelines and has developed a tool to help organizations test their CPOE systems.
"It's so extraordinary to me, but Leapfrog seems to be the only one out there, at least in the public policy world, with a priority on assuring that health information technology is monitored over time. It seems like such an obvious thing that it's amazing that we have to even say it but we know from [our survey that] hospitals don't always know that when they buy technology it's not plug and play. It's something they have to monitor and carefully watch over time or else they can't be sure it's safe."
The Leapfrog Group is founded, in part, on the belief that American healthcare remains "far below obtainable levels of basic safety, quality, and overall customer value." Binder conveys that message clearly. But she doesn't just carp about what's wrong with healthcare; she talks about how to effect change. One example is the partnerships Leapfrog has built with organizations and their supporters, including the March of Dimes, which is currently working with Leapfrog to build awareness and educate providers and patients about the dangers of scheduling elective deliveries for babies before the 39th completed week of gestation, a measure that Leapfrog added to its hospital survey in 2009.
"Community members, leaders, parents, and grandparents are coming together and walking into hospitals and sitting down with doctors and CEOs and saying, 'What are you going to do to improve things?' And it's really impressive. It's a change and a new way of thinking about how we all contribute to improving healthcare," she says.
"We need to ensure that our survey's helpful in making the change. Because our survey is not about an interesting study that sits on someone's shelf. Our survey is supposed to be a dynamic way for us to make real change in a fast way—a fast leap forward."
Like many of the people her organization represents, Binder has had both positive and negative encounters with the healthcare system. She says her father was treated with compassion and received quality care while hospitalized toward the end of his life. Later, the newborn she'd named after her father underwent surgery that resulted in a medical error.
"I have had enough experience with hospitals to realize how important they are, how much I trust in them, and it creates great passion in me that I want them to perform well. Because I don't place that trust in just anything. I expect them to be the best. And all of us as Americans pay for them to be the best. And they aren't always the best."
Although Binder's relationship with the industry isn't always contentious, it's not always warm and fuzzy, either. "I think we're pretty tough and we'll stay tough. But I also understand the challenges that they face and I have a lot of admiration for hospitals. Not only the hospitals that have managed to do extremely well in this tough environment, but the hospitals that have many challenges and don't always do that well, but still manage to be transparent and give it their all," she says.
"Some of our biggest champions are hospital leaders. They have given us ideas, they have given us advice, they've given us great stories in how innovative they've been in figuring out ways to get to zero on infections or engage nursing staff more to reduce preventable injuries—just amazing stories."
"It makes them better at what they do, rather than just reporting what they do."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is David Blumenthal's story.
David Blumenthal, MD, isn't very well known outside of the healthcare industry.
But among healthcare providers—especially IT leaders—he's kind of a rock star. When he speaks at healthcare conferences (he is a popular keynote choice) attendees line up afterward to have photos taken with him.
If you've ever attended one of Blumenthal's speeches, then you've heard the story of how he ended his long-time love affair with his paper prescription pad and embraced electronic health systems, eventually becoming their biggest champion in 2009, when President Barack Obama appointed him as the national coordinator for health information technology and charged him with building a nationwide health information system and supporting the widespread meaningful use of health information technology.
The story goes like this.
In 2002, as a practicing primary care physician at Boston's Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Blumenthal met his first electronic health record.
"It was not a match made in heaven," he admits. But he saw that his younger colleagues liked the EHR. And they expected he would use it, too. So one day he was using the EHR to order a prescription for a sulfur-based medicine for a patient with a urinary tract infection. The patient, it turns out, was allergic to sulfur.
Maybe the pharmacy would have caught the potentially fatal error. Maybe the patient would have said something. But the EHR's red-letter alert meant that Blumenthal didn't have to depend on maybes that day.
When asked what it is about that story that resonates with physicians and healthcare leaders, Blumenthal's response is as carefully phrased as his speeches and has the clipped intonation of the busy physician that he is.
"I don't know if it's effective," he says. "I tell it because it's true. It at least enables me as a physician to talk to other physicians, other nurses, and to show that, A, I understand what they're going through and, B, I think there's value in going through the effort of learning how to use an electronic health system."
Blumenthal has put an emphasis on input and collaboration—backed by regulation in the form of the HITECH Act and some $20 billion in government incentives for those organizations that become meaningful users of HIT. He works with industry trade groups and state and federal offices. He's enlisted thought leaders, formed committees of experts, and sought input from patient privacy and legal rights advocates. He's called on healthcare leaders to be participants and partners in determining the future of electronic health systems.
"We envision a future where information follows patients," he says. "Unconstrained by competitive rivalry, unconstrained by geographic boundaries, unconstrained by cultural disinclinations to collaborate. We want teams to emerge in local communities that make exchange possible. And we will be using the meaningful use framework and all other levers at our disposal to try to make that possible."
Standards and certification, financing, technology, logistics, privacy and security, software and hardware—there are a whole lot of questions for Blumenthal and his team-mates to answer.
How will competitors share health data without compromising the health of their own organizations? How can organizations afford to gamble their own time and money in electronic systems before the stimulus dollars start to flow? How do small physician practices navigate such a complex path to IT? How do they know if they're choosing the right system? And what, exactly, will "meaningful use" mean in future stages of the effort?
"There's no lack of work to be done," he says. "It is hard."
When it comes down to it, though, the answers to all of these questions don't seem as important as the lesson embedded in Blumenthal's story about the patient with the sulfur allergy—that Blumenthal was a better physician with the record than without it.
"These applications will win physician, nurse, and health professional loyalty to the technology. These are the things that will make them committed advocates," he says. "It makes them better at what they do, rather than just reporting what they do. They will see what so many others have seen: That patients are better for it. There is no stronger professional pull than making a professional better at what he or she can do."
The healthcare system is on the cusp of accepting the positive influence of patient experience on quality, says Steve Ronstrom, president and CEO of Hospital Sisters Health System Division and CEO of Sacred Heart Hospital in Eau Claire, WI. In a recent interview, the lead advisor for the HealthLeaders Media Intelligence Report, Patient Experience: Help Wanted, explains how basics such as infrastructure and technology combined with the people skills of empathy and caring can improve outcomes. [Sponsored by Medseek]
The headline for senior leadership editor Philip Betbeze's most recent column is dead on: Hoping for Repeal is Not a Strategy. As we gear up for our annual industry survey season here at HealthLeaders Media, he says he's noticing a disturbing trend: Some healthcare leaders are pinning their hopes for their organization's long-term well-being on repeal of the Patient Protection and Affordable Care Act.
In light of that news, healthcare CIOs and other leaders might want to give themselves a little pat on the back for their response to another federal program—the American Recovery and Reinvestment Act of 2009 and its meaningful use requirements.
As I read through the responses to this year's industry survey, as well as the results of another forthcoming report on electronic health systems, I'm seeing signs that leaders are making strides toward becoming meaningful users of electronic health systems.
The report will be released next month, but I'll give you a sneak preview: A robust number of hospitals, health systems, and physician practices have implemented clinical documentation, computerized physician order entry, ePrescribing, and many other capabilities.
In fact, many healthcare leaders say they started getting ready to meet meaningful use before anyone knew for sure what meaningful use would entail.
On the other hand, reader Mike Martin responded to a story on meaningful use readiness in this month's issue of HealthLeaders magazine by noting that many physicians are "rightfully speculative about the big electronic push based upon some research and experience of others."
He adds: "The number of complaints and unanswered questions are extensive. Is 'Jump on the Bandwagon, we will fix it later,' the best approach to take with physician relations and technology?"
It's a good question. Some say the answer is "yes."
Organizations must push forward despite uncertainty, taking actions such as hiring IT staff and investing in hardware and software now, says Mitch Morris, MD, national leader of HIT for Deloitte Consulting.
"As healthcare IT leaders move forward with their plans, they will want to develop a clear road map," he says. "A meaningful-use road map should include not only goals and expected outcomes, but also timelines, staffing requirements, and a projection of expected capital and operating costs."