The death of a 76-year-old man and a list of other violations triggered an investigation that almost cost Louisburg, NC-based Franklin Regional Medical Center its federal dollars to treat poor and elderly patients. Franklin Regional was found by the Centers for Medicare & Medicaid Services to have acted unacceptably after the elderly patient arrived at the hospital for an elective knee surgery and complained to the nurse that he had chest pains and loss of feeling in his left arm. The man died of heart failure the following day. The case is one of several failures outlined in a 44-page report from the CMS, resulting in a threat to pull Franklin Regional's federal funding, a major revenue stream for the hospital.
At the Ann Myers Medical Clinic, physicians in a variety of specialties from around the world congregate to teach medical students treatment protocols, how to analyze diagnostic images, and other critical skills that will improve patient care and make them better overall doctors. And when the physicians are done teaching, going home is as easy as logging off and powering down their computer—the clinic is located in Second Life, an Internet-based virtual world.
Physicians sometimes get a bad rap when it comes to technology because of low adoption rates for electronic medical record systems, e-prescribing, and other practice-enhancement technologies, but it’s typically cost barriers, not a Luddite aversion to technology, behind physicians’ reluctance to wire their practices.
Many physicians are actually very savvy, particularly when it comes to online interactions—99% of all physicians now use the Internet, according to a recent poll. In fact, I would say physicians are ahead of the curve when it comes to finding practical, professional uses for Web 2.0 technology.
The entire Web 2.0 trend is based on the notion that Web design can facilitate information sharing and collaboration among users, so it’s almost the perfect vehicle for physicians who are short on time but accustomed to constantly learning new clinical and practice management techniques from their peers, says Michael Banks, MD, co-founder of The Doctor’s Channel, a start-up video sharing Web site that provides condensed medical education videos for doctors.
The Doctor’s Channel is a prime example of how physician-centric online communities can save doctors time and make their day-to-day work a little easier—physicians can watch short video clips about everything from specialty-specific treatments to reimbursement advice. “They learn much like they do in a live setting where they may have a quick conversation with a colleague about a clinical topic or talk to someone in the hall to get the most current information, and then move on with their busy day,” Banks says. And there’s an added benefit professional benefit: Some of the 5- to 7-minute video clips can actually earn doctors “micro-CMEs” worth 0.25 CME credits each.
In today's fast-paced world, sites like these allow physicians to overcome pesky geographical limitations to interact with more of their colleagues in less time. Other examples of doctors taking a Web 2.0 approach to medicine include:
Blogs. Physician blogging has been around for a while now, and there are dozens of great physician-written blogs about everything from clinical procedures to healthcare reform. Some doctors use this medium to vent or write creatively, but others share information with colleagues or even use a blog as a marketing vehicle. I probably get more quality industry news and information from reading medical blogs than from any other source (other than HealthLeaders, of course).
Wikis. AskDrWiki, for example, was started by a group of cardiologists and claims its goal is to create “a collective online memory for physicians, nurses, and medical students.”
Online communities. With nearly 60,000 physician members, Sermo is by far the most popular of the online social networking communities, but it’s not the only one. Ozmosis is a place where physicians can “share clinical, practice, and policy insights” with peers. Physicians have responded enthusiastically to social networking, and new online physician communities are popping up regularly.
E-books. Like wikis, e-books serve as an online repository for medical information, taking the volumes of clinical information that used to be stored in libraries and physicians’ bookshelves and making them accessible to anyone with an Internet connection. MedicalStudent.com, for example, houses medical textbooks complete with anatomical diagrams and pictures.
This is just a scratch on the surface of current Web 2.0 offerings, so if I've missed a site that you regularly use, please send it along. The Internet will play a major role in the future of healthcare, and a lot of physician leaders have already found ways to use Web 2.0 to tackle some of the daily challenges they face.
As I was putting together this week’s edition of QualityLeaders, the Centers for Medicare & Medicaid released nine new proposed “never events” that hospitals won’t be reimbursed for if they are acquired while a patient is receiving care at the organization.
These conditions include:
Blood clots in the vascular system
Bloodstream infections
Ventilator-associated pneumonia
Legionnaire’s disease
Delirium
Collapsed lung as a result of medical treatment
The nine new conditions on the “won’t reimburse” list aren’t much of a surprise to anyone. Many of the quality leaders I’ve spoken with in recent weeks seemed to expect that the original eight on CMS’s list would soon have company. Some even went so far as to say that the first eight were the “low-hanging fruit” or the most obvious of the conditions that hospitals must take care of to provide quality and safe care to patients. But what do these new additions tell us about where CMS is headed? Are they reasonable?
James Kennedy, MD, CCS, of FTI Healthcare in Brentwood, TN, told my colleague Lisa Eramo that although the majority of the new conditions listed by CMS are reasonable, there are some that raise eyebrows. For example, patients can acquire Legionnaires’ disease both in and out of the hospital setting, particularly through air conditioning units that contain waterborne pathogens. Certainly, he says, patients have acquired the disease from hospital air conditioning units, but it isn’t clear how hospitals will determine if the condition was present on arrival.
The additions of clostridium difficile colitis and delirium have also been questioned, as these two conditions often occur as a side effect of medication or being in the hospital for expanded periods of time.
Fortunately, CMS gives us until June 13 to comment on these proposed additions before it releases the final rule on or before Aug. 1. Will you be sending your comments? If so, what will you tell them? Do you think your feedback will be addressed in the final rule?
A note to my faithful readers: In last week’s column, I promised to introduce you to more “zero heroes.” I haven’t forgotten about them. Stay tuned.Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
The Office of the Inspector General has recently published "An Open Letter to Health Care Providers." In the letter, the OIG says "refinements to its Provider Self-Disclosure Protocol process are intended to provide an opportunity for providers to work with OIG to more effciently and fairly resolve matters appropriately disclosed under the SDP."
Scott Haig, MD, recently moderated a round table with four orthopedic surgeons about how to deal with the digitally-empowered patient. Some physicians viewed digital empowerment as a good thing, while others raised concerns about know-it-all patients. Physicians in the roundtable discuss how patient empowerment by the Internet, as well as other factors, is changing their current practice and what they see in their future.
Drug maker Merck drafted dozens of research studies for a best-selling drug, then lined up prestigious doctors to put their names on the reports before publication, according to a report. The report provides a look in the industry practice of ghostwriting medical research studies that are then published in academic journals. The authors of the study say it raises broad questions about the validity of much of the drug industry's published research, because the ghostwriting practice appears to be widespread.
When planning your Web site design, begin by searching a few other physician practice Web sites in your immediate area. Note the features of the site that appeal to you, as well as those areas that would not work for your practice.
Another helpful technique is to pretend you are a patient attempting to get information about your office. What information do you want and where would you tend to look for it? Provide your webmaster with a list of sites you find outstanding, and work with him or her to emulate the most appealing characteristics of each.
Aim to give visitors to your site an interactive experience. For example, if you have a practice brochure or newsletter, invite patients to download it.
Consider the following interactive possibilities that would allow patients to:
Submit completed forms online Print forms to fill out at home and bring to the office
Schedule appointments directly into the software program
E-mail requests to appointment personnel
Receive billing information
Access their balance information
Make direct payments by credit card, PayPal, etc.
E-mail the billing department
Learn about procedure preparation instructions (e.g., preparation for colonoscopy or nuclear medicine study)
View pictures of outside signage and procedure rooms
At a minimum, be sure to include the following information:
Full name of practice
Practice location(s)
Provider name(s) and bio information
Hours of operation
Services available
Insurance information
Contact information
Office policies
Refill requests
Referral requests
Financial issues
Emergency contact information
Medical records release
HIPAA notice
Carefully interview any Web designers that you have chosen to build your site. Ask them about all costs associated with the site, including how many changes you can make without incurring additional charges. When you launch the Web site, you will make multiple changes within the first year. Contact your local specialty societies to inquire about any discount programs available for Web design through your membership.
A patient’s first impression of your Web site is important, so do your research. The benefits to your practice will be enormous.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor’s Office, a publciation by HealthLeaders Media.
In part one of a three-part interview, James Hartert, MD, MS, Chief Medical Officer for MinuteClinic discusses the collaborative approach the convenient care clinics seek with physician practices.
The director of the Agency for Healthcare Research and Quality says pharmacists have an important role in improving medication safety in emergency departments. Carolyn M. Clancy, MD, emphasizes the growing need to employ pharmacists to reduce the risk of adverse drug events in the EDs. Clancy adds that the "Introducing an Emergency Pharmacist into Your Institution" initiative helps hospitals obtain support for and implement emergency pharmacist programs.
New York State Sen. Kenneth LaValle said he plans to reintroduce legislation by to put "more teeth" into Stony Brook University Medical Center's oversight board. The oversight board was not informed until recently of a case in which diseased organs were transplanted from a 15-year-old Sag Harbor boy. LaValle also wants to introduce a bill to ensure that transplant doctors statewide are following best practices.
