Only 1.5% of the nation's roughly 6,000 hospitals use a comprehensive electronic record, and even that statistic belies how hard it will be for healthcare to jettison its 19th-century filing system by 2014. It took Children's Hospital of Pittsburgh, for example, seven hard years and more than $10 million to evolve a system that lets its doctors check on patients with a few mouse clicks from anywhere and use speedily up-to-date records in directing their care. This article from the Associated Press charts Children's efforts.
For the last year, parents have been banned from sleeping with their sick babies at St. Christopher's Hospital for Children in Philadelphia.
The hospital instituted the policy after three infants over three months were pronounced dead in the emergency room after bed sharing-related accidents at home. The hospital's ER typically gets one such death every couple of months. But the tragedies early last year inspired St. Christopher's nurses to propose that the hospital lead by example.
As of July 1, all nurses and caregivers in Pennsylvania are now largely immune from management requests to work "mandatory overtime." The extra hours, nurses say, were frequently tacked on the end of already long hospital shifts, jeopardizing patient care and making it tough to keep quality nurses. For much of the decade, nurses and the Service Employees International Union have been lobbying for a change in state law that would restrict hospitals' ability to force nurses and support staff to work overtime hours. Fourteen other states have similar laws and regulations on the books.
A Tennessee healthcare policy group plans to publicize the results of a springtime survey that showed a majority of small businesses want a larger government role in providing healthcare to more Americans, but many of them also have questions about cost and quality. The small-business survey found that 61% of 245 companies that responded to a survey mailed in March said they support a stronger government role in "guaranteeing access to quality affordable health care," according to the report's authors.
Thousands of patients face a reduction in state healthcare benefits through an effort under way this summer to re-evaluate TennCare coverage for 154,000 Tennesseans. Many of them are having their eligibility reviewed for the first time in decades. After a 22-year-old court order was lifted earlier this year, TennCare is now asking a group of people to prove that they are truly worthy of coverage. The group includes thousands of people with chronic medical conditions, including those with severe disabilities and mental illnesses.
A research letter published in the Archives of Internal Medicine looked at the results of a two-month study of more than 10,000 pages sent at two Canadian hospitals. The study found that 14% of pages sent internally never reached the intended doctor because he or she was unavailable. Close to half the pages reviewed for the study were urgent, including one related to a patient with a dangerously high glucose level requiring a prescribed medication. The study did not look at the effect of the missed messages on patient outcomes.
California quacks, look out. As of July 1, the Medical Board of California now has unlicensed practitioners in its sights with its revitalization of "Operation Safe Medicine."
The team of four investigators plus staff will focus full-time on unlicensed practitioners, especially those from Mexico or "Hollywood-culture doctors from other countries" who try to sell unapproved procedures and treatments, says medical board spokeswoman Candis Cohen.
Many of the unlicensed practitioners "prey on sick and desperate patients," many of whom have low income, she says.
"Because of its underground nature, it's impossible to know the extent of the problem in California," Cohen says. Investigators believe that with those so far discovered, "we are just scratching the surface. We need more patients to come forward."
The board licenses 125,000 physicians. After lengthy investigations verifying allegations of misconduct, the board refers those doctors for discipline through the state Attorney General's office.
With this office, the board now has a team dedicated just to systematically finding and stopping unlicensed practitioners, especially those who have the potential to harm patients.
Many of the illicit treatments include unlicensed drugs or herbal remedies from other countries or surgical "cosmetic" procedures geared to changing one's physical appearance. And, many of the illicit practices have been found in Los Angeles and surrounding areas, Cohen says.
"Many in the physician community in California have been horrified at the disfigurement they have seen at the hands of unlicensed individuals," Cohen says.
Examples of recent cases that have come to the board's attention include these unlicensed and often, untrained, practitioners:
A woman who dispensed non-prescription drugs she injected in women in the bathroom of a swap meet. One of her victims died the following day at home.
A man who performed breast augmentation procedures resulting in severe infections and disfigurement in his patients.
A female who injected corn oil into victims' buttocks. One almost died from a fat embolism.
A man who administered vaccinations, allegedly as part of an immigration process, but the vaccines turned out to be saline injections, thus failing to protect a larger population.
A practitioner in a laser clinic who was allowed to work with insufficient supervision who burned his patient.
An individual who used the wrong device to remove a tattoo, and instead branded the patient.
The practitioners lack qualifications and training, and their care all too often results in "dangerous reactions and infections from faulty diagnosis, untreated disease, health complications and even deaths," the board said in its recent newsletter.
Cohen says that in the past, unlicensed activity has taken place in beauty shops, private homes, even doctors' offices "as when doctors aid and abet the unlicensed practice of medicine because they don't want to pay an assistant who is licensed."
In an effort to prompt more patients to be aware that physicians can only practice in the state if they are licensed by the board, the agency now seeks approval to require all practicing physicians to notify patients they are licensed.
Physicians have three ways to comply. They can post a sign in their offices, include it in a written notice signed by the patient, or include the notice in routine statement, such as discharge instructions, that require the patient's signature. The rule is sought so more patients will know there's a state agency ready to receive their complaint. That option is not as clear with an unlicensed provider from outside the state or the U.S.
The new Operation Safe Medicine office, which will cost about $600,000 a year and be paid from licensed practitioner fees, is actually being reestablished from a similar operation that began in 2000.
During portions of 2001, 2002 and 2003, board investigators caught 146 unlicensed practitioners, whom they referred for discipline to city and district attorneys for criminal felony and misdemeanor prosecution.
"The OSM had become an effective mechanism for dealing with unlicensed activity and the so-called backroom clinics in the Los Angeles and Orange County areas," the board said in a recent newsletter.
But as sometimes happens, the unit had to close in 2003 because of budget shortages. Investigators were transferred to traditional units in which investigators looked into problems involving the state's licensed physicians.
Because of OSM's previous success, however, the board voted in 2007 to reestablish the unit, but it took 18 months to gather data and submit a budget change, Cohen says.
"The Medical Board is pleased that with the reestablishment of OSM we may once again proactively protect the public against the unlicensed practice of medicine," says executive director Barb Johnston. "This unit is staffed by highly trained, Medical Board investigators who are solely dedicated to stopping and preventing the unlicensed practice of medicine and the corporate practice of medicine."
The board is establishing the revitalized team in Rancho Cucamonga, in Southern California, first but hopes to soon have a Northern California office as well. However, the renewed OSM office will be in place only for another two years and will require the board to justify its continuation to the Department of Finance.
Step into the office of Brandon Ho, HIPAA compliance specialist for the Army in Honolulu, and you won't see a compliance officer scrambling through mountains of paperwork regarding new HIPAA laws.
President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009 that includes new HIPAA laws, and Ho is certainly aware of them.
But panic? Urgency?
Not quite.
"Overzealous compliance," Ho says when HealthLeaders Media asked him what was the No. 1 pitfall for HIPAA privacy and security officers. "I've actually seen privacy practices where providers are so overly zealous with regulations and compliance with HIPAA that they end up spending more money than they ever have to. They just have to look at ways to comply in the best and most efficient way."
Ho says even with new HIPAA laws (in the Health Information Technology for Economic and Clinical Health Act), privacy and security officers need to keep it simple and not feel the need to revamp the house.
Ho, affectionately called "The HIPAA Guy" at Pacific Regional Medical Command, Tripler Army Medical Center, spoke to HealthLeaders Media about his HIPAA compliance program at his Honolulu facility and the 121st Medical Group in Korea and Camp Zama in Japan.
He also offered advice for fellow HIPAA privacy and security officers in a time of changing laws and regulations and increased patient awareness of privacy rights:
1. "Don't muddy up the water." "Despite the fact that HIPAA is always changing," Ho says, "there are always going to be some consistent truths. You can take all the nuances of all the new laws and requirements, but basically HIPAA to me is always going to be about authorization and whether patients feel OK that information is going to be disclosed."
2. Check on existing policies. Much of the new HIPAA laws and requirements point to compliance that should already be covered. For instance, HHS said information that is encrypted by NIST standards is secure PHI and therefore not considered a breach of security. "If everybody is scrambling because of these new laws, they're going to have to check their programs to see whether it's truly about complying with patient needs or just about complying with laws."
Too many compliance officers, Ho says, are concerned with laws and do not ensure patients are aware of their rights and are part of the decision-making.
"It's about empowering your client base," Ho says.
3. Make patients comfortable. The healthcare experience has to be a holistic approach, Ho says. "You need to make sure patients are comfortable at all levels," he adds. "They have to not only trust their doctors but also the people supporting their doctors."
4. Let people know you're there. Marketing your HIPAA office is key, Ho says. If you're located in the basement next to medical records, get out.
"The HIPAA officer should be in a place where they are easily accessible to patients," Ho says. "And let people know who you are. Put your name out there. Walk the halls. If people know who you are and see you around, it lets them know you're there for them."
5. Buck the trend of training simplification. "People want a one-stop shop for all training, but I believe that is the biggest problem with training today," he says. "The exact same booklet training, or video training, or classroom training shouldn't be given to everyone. People have all different HIPAA concerns and, because of that, you need more focused training."
6. Keep things interesting. "I'm always trying to entertain them," says Ho. "People always like to hear the lascivious details. So I talk about what happened to Britney Spears and … the Octomom [Nadya Suleman] because whenever you talk about money and fame, people get interested."
As the long-term care industry moves toward a resident-centered approach to care, the quality of life provided to nursing home residents is facing increased scrutiny. Although most SNFs are eager to improve the quality of life in their facility, many do not know where to start. Fortunately, the Advancing Excellence in America's Nursing Homes Campaign is here to help.
The Advancing Excellence Campaign aims to help nursing homes make a difference in the lives of nursing home residents and staff by monitoring key indicators of nursing home care quality, promoting excellence in care giving, and providing free, evidence-based resources nursing homes can use in their own quality improvement efforts.
"The campaign promotes partnerships between nursing home residents and staff and strives to help facilities help themselves by improving the quality of care they provide," says Mary Jane Koren, M.D., M.P.H., chair of the Advancing Excellence Campaign.
Participation in the campaign is voluntary and open to nursing homes, caregivers, consumers, and other quality of life advocates. Participating nursing homes commit to at least three of the campaign's eight goals and their progress towards meeting these goals is regularly monitored.
The eight goals of the Advancing Excellence Campaign are:
Reducing the prevalence of pressure ulcers
Reducing the daily use of physical restraints
Improving the management of pain in long-stay residents
Improving the management of pain in short-stay residents
Setting individualized targets for clinical quality improvement
Measuring resident and/or staff satisfaction and incorporating this information to quality improvement activities
Decreasing staff turnover and developing action plans to improve staff retention
Increasing use of consistent staffing assignment
"We are tracking the results and are able to show that the participants are actually improving faster and further than those who aren't involved in the campaign," Koren says. "Nursing homes can really benefit from participation in the campaign so, if your facility is not yet a participant, I encourage you to join. If you've already joined, keep working to improve the quality of life at your facility."
Nursing homes can sign up for the Advancing Excellence in America's Nursing Homes Campaign on the campaign's Web site, www.nhqualitycampaign.org.
According to Max Reiboldt of the Coker Group, next year will bring more of the same problems, including less reimbursement and an increased burden on providers. He predicts a continued consolidation of services, increased government involvement, and a continued emphasis on quality and clinical outcomes.
