Pharmaceutical students at Keele University in England are using a "virtual patient" to help in their training. Students interact with computer-generated characters to gain experience in effective communication and decision-making. Learners talk with the "patient" via voice recognition technology or by typing questions into a standard computer interface and the "patient" responds verbally or with a range of non-verbal gestures to indicate emotions such as pain, stress, or anxiety. At the end of the session, the "patient" gives feedback to the trainee about their performance.
Efforts to use information technology to improve U.S. healthcare will fall short of the potential seen by health leaders and could even set back the cause, according to a report from the National Research Council. A committee of academic and industry experts found the information systems at eight U.S. medical centers noted for leadership in information technology failed to provide timely, efficient, safe and patient-centered care.
Standardized patient health insurance identification cards got a nod of approval from Humana Inc., one of the nation's largest health insurance companies. Humana is the first company in the industry to publicly pledge its support to the Medical Group Management Association Project SwipeIT. The project is an industry-wide initiative to advance the adoption of standardized patient health insurance ID cards containing machine-readable information.
Comparing a traditional wired network to a wireless one is a little like comparing a pet rock to a puppy. One sits inert, waiting for you to do something with it, while the other trots right along with you, demanding constant attention. Ask just about any CIO who has built a wireless infrastructure from the ground up, and he'll tell you that it's an expensive, time-consuming, and demanding undertaking.
In a financial climate where even the biggest hospitals are pinching pennies, making a major capital investment to expand your wireless network by installing a distributed antenna system (DAS), for example, may not seem like a prudent idea. And, with about 74% of CIOs reporting they already have some version of a wireless network in place, according to the HealthLeaders Media Industry Survey 2009, it's likely wireless has not been included in many hospitals' 2009 IT budgets. But like the rest of IT, the wireless market is evolving fast, and if you wait too long to upgrade, you could find yourself falling behind the curve.
Chief information officer Rich Pollack says positioning Virginia Commonwealth University Health System's Critical Care Hospital to meet future wireless demands was what he had in mind when he proposed installing a DAS in the new facility. The 500,000-square-foot, 250-bed hospital was designed and built from the ground up with wireless capability built into the infrastructure.
"We have 95% to 100% coverage wall-to-wall and floor-to-ceiling for every floor in hospital. That covers the gamut from telemetry, cell phones and PDAs to clinical carts, laptops, tablet PCs, pagers and two-way radios all on the one system," says Pollack, who says the system spent about $1.5 million on the hospital's wireless infrastructure. Pollack says that even with the challenges posed by installing the system, the investment is worth it.
"On the IT technical side, what we have now is much more demanding. With a wired PC, if it's installed correctly, you can forget about it for the next three or four years. It just kind of works. Wireless requires constant attention and tuning and adjustment and monitoring. It also requires a higher level skill set than you will typically see the average IT department," says Pollack, who recently hired two wireless engineers to help maintain the system.
So what is the payoff of investing a million or more just for wireless?
1. Cost savings (eventually). Let's say you are one of those cutting-edge CIOs who have already begun using an EMR. If you want to get the full benefit of that EMR, you have to have ubiquitous access to it just like you would with a paper chart. To do that in a wired environment you would have to install a PC in every nook and cranny in the hospital, says Pollack. "You're talking about the cost of hundreds and hundreds of PCs and ridiculous amounts of wired infrastructure," he says. Not only that, but the cost of moving just one wired desktop from area "A" to area "B" can alone cost thousands of dollars, he says.
2. Increased patient safety and quality of care. Those words are bandied around a lot, but in few cases are they truer than with a highly reliable wireless system. When the University of Chicago Medical Center decided to install a DAS, Michael Sorensen, executive director and chief technology officer, says the speed of access to information was a major selling point for him. "In the past an alert would go off and the turn-around time for it to be acted on could stretch out for an hour while the data was retrieved and the physician found. Now, it's seconds or minutes," he says. Sorensen, like Pollack, hired engineers to handle the new system, but says the benefits far outweigh the costs, with increased clinical efficiency, increased accuracy of data, reduced medical and transcription errors, faster workflow, and quicker results.
3. It is the trend. Happy clinicians make a happy hospital. And while the initial training process may be painful, both Pollack and Sorensen say the staff at their respective hospitals now wouldn't have it any other way. "This has become an expected underlying technology over the past three years among caregivers and clinicians," says Pollack, who notes that the system is considering retrofitting its older facilities with a DAS.
According to the HealthLeaders Media Industry Survey, nearly 86% of CIOs say they are planning to increase IT spending over the next five years. Sounds to me like including a wireless upgrade in your plans might be a smart move. After all, do you really want to be the last hospital running solely on DSL?
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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A Better Mousetrap
A new generation of collaboration has been tested in Minnesota through the Institute for Clinical Systems Improvement. This is a partnership between payers and providers.
Once it is determined that a diagnostic imaging exam is needed, the patient and physician together review the appropriateness criteria. This decreases the many back and forth calls to the insurance company, creates a bonding experience between the patient and physician and provides the physician the additional security of knowing the best test was ordered for his patient. It also improves patient flow and clinic efficiencies.
For the patient, the test is ordered with fewer delays and rescheduling and contributes to faster diagnosis and initiation of care.
Health plans benefit through reduced staff to support prior notification and consistent appropriateness criteria.
Employers reduce employees' exposure to harmful radiation and are assured that their employees are receiving appropriate care.
6. Care integration capability. includes payer-provider collaboration, regional health information organizations, virtual care delivery, and e-prescribing.
The market leading organization reaches beyond traditional modes of collaboration and communication—like the pilot mentioned earlier in Minnesota. These tactics can provide great benefits.
7. Evaluation and improvement capability> is the collection and measurement of data to evaluate processes and programs. This includes data repositories, clinical informatics and benchmarking, outcomes measurement, process tracking, and reporting.
Market leaders not only have a data repository but data is easy to extract and manipulate. All clinical and member specific data populate the data repository regularly to be used effectively.
In the area of Diagnostic Radiology, not all reports are created equal. In a study in Academic Radiology, a study focused on the American College of Radiology standards, it was found that 86% of reports were deemed as satisfactory. A focus on radiology reporting could enhance the value from the test. Another survey in Radiology Reporting stated that 49% of referring physicians did not feel that the radiology report sufficiently addressed the current clinical question.
Focusing on improvement in radiology reports can benefit all stakeholders.
Market leading organizations use business intelligence gained from data. For example, by reviewing ordering patterns, problematic ordering patterns can be identified. Cost and utilization data can be used for facility contracting. Member satisfaction can identify quality of imaging facilities. Pricing information can aid in transparency—important as patient responsibility continues to grow.
8. Provider relationship management> Includes pay for performance, transparency, and network strategy. Becoming customer-centric requires more than just thinking about the potential benefits of these activities, it requires implementation.
Market leading organizations focus on improvement. Pay for performance and high performing networks can be used for adherence to clinical guidelines, better radiology reports, and higher quality for patients. Network strategies can target the most qualified providers (Radiologists and equipment—credentialed and accredited) to provide optimal access, accurate and complete clinical information through reporting, and network access to enhance the patient experience. Benefits include better patient care and communication, decreased cost and risk to the payors. A well-designed program results from integrated collaboration from quality management, network, payer, and patient involvement.
With data, the link can be made between radiology utilization and outcomes. This data can be used for identification and confirmation of health patterns, benchmarking, measurement of the efficacy and safety of certain treatments, variation, identification of high quality, low cost providers, and comparative benchmarking.
Radiology is moving towards an evidence-based, decision-making model. Employers, consumers, payers, and providers are demanding credible and actionable data.
To move ahead, a payor can review the use of advanced diagnostic imaging, create a steering group to develop strategies for implementation.
Measuring value is imperative.
Truly successful care management looks beyond one diagnostic test and at the full value chain. With time intensive processes imposed on one link in the chain, the chain can break. Only through collaboration of the patient and provider can a solution be achieved that is sustainable long-term. Patient care and patient outcomes benefit.
Marybeth Regan, PhD, is an expert in disease and care management. She has written numerous articles on strategies for care and disease management. She may be reached atDrmarybethregan@aol.com.
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New York Attorney General Andrew Cuomo has announced that two additional regional insurers have agreed to pay more than $600,000 to help establish a new independent database to determine the rate they pay doctors and hospitals out of their network. Cuomo said Independent Health, which insures about 365,000 people in western New York, has agreed to pay $475,000, while HealthNow New York Inc., which insurers about 800,000 people in the state, will contribute $212,500.
The American Medical Association announced it is suing health insurers Aetna Inc. and Cigna Corp. for allegedly using rigged data to under-reimburse physicians. The medical associations of several states are suing the companies as well, as are individual physicians. Two lawsuits were filed in New Jersey federal court accusing the companies of using a system aimed at underpaying physicians and forcing patients to pay excessive costs for more than a decade.
Pfizer Inc. has announced that it will become the latest drug maker to publicly disclose the payments it makes to doctors. Pfizer will report all payments to doctors of more than $500 for consulting and speaking arrangements and will also make public the money it pays them to participate in its clinical trials. Federal legislation could soon mandate such transparency from the entire industry.
Healthcare advocates are actively campaigning to persuade Barack Obama to cross Democratic Gov. Phil Bredesen of Tennessee off his short-list for secretary of Health and Human Services. At issue are cuts Gov. Bredesen engineered to Tennessee's Medicaid program, removing 168,000 people from the program in an effort to control costs. And, in an unusual move for an official under consideration, the governor is fighting back publicly.
The University of Chicago Medical Center is changing the way it admits emergency room patients as part of its effort to deal with the worsening economy, a move underscored by its announcement of 450 layoffs, or 5% of its workforce. The decision to introduce what amounts to a new version of patient triage represents an aggressive and unusual move by one of the city's premier hospitals to cope with spiraling costs and the long waits for emergency treatment. Some don't like the plan, but the U. of C. says it has no choice: The academic medical center said 40% of the 80,000 patients who go to its emergency room each year do not need to be there. These visits cost the hospital tens of millions of dollars a year.
