Allowing patients access to their personal medical records is a decades-old idea that predates electronic medical records. Yet, the idea has yet to catch on.
Susan Frampton, president of Planetree, says the association of patient-centered care healthcare providers has for the last 20 years asked its members to allow patients access to their medical records, but with limited results. Of the 150 acute care hospitals in Planetree, only about 25% have opened their records to patient scrutiny.
"It has probably been the one most challenging practices that we have asked our members to do," Frampton says. "There is a lot of fear on the part of medical and nursing staff and that translates into resistance, in part because they are afraid of the potential for litigation if the patient reads something in their chart that they don't like the sounds of."
Hospitals and physicians in three states announced this week a 12-month pilot project that they hope will rekindle the movement and measure the impact of patient access to medical records. Funded through a $1.4 million grant from the Robert Wood Johnson Foundation Pioneer Portfolio, the OpenNotes Project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter.
The pilot project will involve about 100 primary care physicians and 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle.
"Patients remember precious little about what happens in the doctor's office," said Tom Delbanco, MD, a primary care physician at BIDMC and a Harvard Medical School professor, in a media release. "We expect OpenNotes will improve patient recall, help patients take more responsibility for their care, and offer an opportunity for avoiding potential medical errors as patients and families monitor and think about their care in a much more active and knowledgeable way."
Delbanco and Jan Walker, RN, an instructor in medicine at BIDMC and Harvard Medical School, recently coauthored a report in Journal of General Internal Medicine that found that most consumers want full access to their medical records.
"We learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care," Walker said, adding that patients expect that in the near future they will be able to rely on electronic technology for many routine medical issues.
Frampton says the problem isn't convincing the patients. The problem is convincing the medical staff and nurses who fear potential lawsuits, even though hospitals that have opened their patient records are reporting a decrease in lawsuits.
"There is still this misperception that patients might see something they don't like or aren't prepared for so that could be a liability," Frampton says. "If you look at the malpractice literature, patients don't sue because there is something in the charts they don't like. They sue because they feel abandoned or that nobody is paying attention to them or things are being hidden from them."
Frampton says there is also resistance from the nursing staff. "There may be things in the charts that the nurses aren't fully prepared to discuss with the patients," she says. "Maybe it's the doctor's notes and the patient questions the nurse and the nurse may feel like he or she is caught in between."
Stephen Downs, an assistant vice president at RWJF and member of the foundation's Pioneer Portfolio, said that much of the debate among physicians about the value of open medical records "is largely uninformed by evidence."
"In the context of a physician's day-to-day work, opening up notes is a subtle change . . . but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care," Downs said.
To collect evidence, physicians and patients will use a one-step intervention to share all encounter notes online. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the impact of OpenNotes through surveys of both groups of doctors and patients.
"While this intervention potentially could disrupt the current flow of primary healthcare, it holds considerable potential to transform the doctor-patient relationship," Delbanco said. "By enabling patients to read their clinicians' notes, OpenNotes may break down an important wall that currently separates patients from those who care for them. It may promote insight and shared decision-making by bringing closer together the unique expertise of the clinician and the unique understanding of himself or herself that each patient possesses."
Frampton says that hospitals don't need an expansive study or special advisors to open their medical records. "You just have to do it. What we have found with hospitals that have just done it is that none of these problems materialize," she says. "Essentially what it does is improve patient satisfaction and helps patients feel a sense of trust that there are no secrets being kept."
Frampton says a growing number of patients—particularly baby boomers—want to be informed about the care their getting. "They want to know what is in there, they want to know what the plan is and they want to know what the results are," she says. "People who don't want to see their charts just elect not to look at it if it is presented to them, and that choice needs to be presented."
Once hospitals clear the misperception of liability or 'how do I handle the patient's questions,' Frampton says it's a win-win situation. "The better informed the patient and the family are, the better equipped they are to ask educated questions and to be more compliant with treatment," she says.
What about start up costs?
"It doesn't cost any more money," Frampton says. "If you happen to have EMR and computer screens in the patient rooms, it doesn't cost any more to tilt the screen so the patient can see it."
Rather than cost, Frampton says, it's a matter of how you practice.
"The nurse has to go over the doctor's notes or the plan of treatment anyway, so there is no reason that can't be done at the bedside, out loud, and with the patient and the family following along and having an opportunity to ask questions. It's just about changing the way you handle the chart to be more open and do more things with the patient.
Tenet Healthcare Corp. said yesterday it has ended acquisition talks with Healthscope Limited, the second-largest private hospital company in Australia.
"Due to the sequence of events associated with the acquisition process, including the premature disclosure of non-public information regarding Tenet's preliminary interest in Healthscope, Tenet has been unable to complete the work necessary to thoroughly convey to shareholders the potential value, including the inherent risks and opportunities, of this transaction," the Dallas-based hospital chain said in a media release.
"Although the due diligence process has commenced, it is in the early stages and has not proceeded as quickly and completely as anticipated. Tenet has concluded that in order to eliminate a prolonged period of uncertainty and market speculation surrounding this possible transaction, it is best to withdraw from this process."
Last week, Tenet confirmed the usually confidential discussions were under way to quell rumors that it said were affecting Tenet stock.
Healthscope owns and operates 43 hospitals representing approximately 15% of Australia's private hospital market, and also operates the country's third-largest pathology business.
Hospitals have a lot to fret over right now. Amid staffing shortages, enhanced competition, aggressive whistleblower suits, new infections cropping up, and abrupt cuts in reimbursements, it's small wonder that hospital violence has not gotten the attention it deserves.
Thankfully, this appears to be changing. The Joint Commission last week issued a well-timed Sentinel Event Alert on violence in the healthcare setting and noted that a "significant increases in reports of assault, rape, and homicide had occurred, with the greatest number of reports in the last three years."
My colleague at HealthLeaders Media, Cheryl Clark, wrote a comprehensive review of the report. For the sake of time I'll refer you to her story.
The opening paragraph of the JC report, however, is worth repeating. It states: "Once considered safe havens, healthcare institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide. As criminal activity spills over from the streets onto the campuses and through the doors, providing for the safety and security of all patients, visitors and staff within the walls of a healthcare institution, as well as on the grounds, requires increasing vigilant attention and action by safety and security personnel as well as all healthcare staff and providers."
Hospital violence is a theme that I have touched upon recently, both in this HR column and in our flagship HealthLeaders magazine, because I've been reading and hearing with alarming regularity about the problem. It's unnerving to read the words "assault, rape and homicide" used to describe events inside a "hospital."
As I wrote in an earlier column, Bureau of Labor Statistics data show that for every 10,000 hospital workers, eight workplace assaults resulted in missed work days. By comparison, in the overall private sector, only 1.7 workplace assaults resulted in missed work for every 10,000 workers.
Don't despair—regardless of the grim statistics. The cause is not hopeless, and I believe this disturbing trend can be reversed starting with a combination of employee training and public awareness. The good news is you don't need a national, top-down mandate, or a special report–however timely and welcomed–from The Joint Commission to determine the potential for violence in your hospital.
It starts with a workplace assessment to identify acts of violence and threats of violence at your hospital. One critical component of that assessment includes asking for–and listening to–the concerns of your clinical staff. These are smart, veteran professionals who–though they may not be experts in security--more than likely have a very realistic sense of the potential for violence in their workplace. They can help identify the real threats, and avoid the rabbit holes that waste time, energy, and morale. Your assessment might include observing first-hand nights and weekend shifts in the ED. To my knowledge, hospital violence rarely occurs in the C-Suite.
When you've assessed the threat, fashion the response. This could likely vary greatly depending upon the healthcare setting. Metal detectors; scenario training; armed security; heightened video surveillance–these are calls that each hospital has to make on its own.
Regardless of the setting, your hospital should have a prescribed approach to workplace violence, where every employee knows how to respond, where to go, where to direct patients and visitors to safety. Your employees will embrace response training, where staff are not working at cross purposes in times of great stress.
Another critical component is raising public awareness about the threat. First, your hospital should very publicly adopt a zero tolerance policy for violence. Hold a media conference and invite your newspaper, local TV, and radio. You don't need to have had a violent incident at your hospital to take a proactive stand. Explain the growing trend and your local concerns.
Of course, "zero tolerance" is largely symbolic. Words alone will not stop the violence. However, stating the case against violence puts the issue in the public consciousness. In effect, you are making your concerns the public's concerns. And you are inviting–if not obligating–local media to join your cause.
The public has been largely mute on the issue of hospital violence because the public does not understand the extent of the issue. It is your job to educate them. They will respond, because there is something particularly heinous about violence against healers. It strikes a chord.
With public support and media awareness, you can take your concerns to your local and state elected officials. If needed, laws can be enhanced or enacted. Perhaps additional funding for security can be had.
The data show that hospital violence is on the rise, even as crime in the overall society is hitting record lows. I hate to say this, but let's not wait for a potential Columbine-like mass shooting at a hospital before we take up the cause. Let's act now!
I would like to hear from readers about how they've tackled violence in the healthcare setting. How severe is the problem in your workplace? What has worked for you? What hasn't? What have been the toughest hurdles? Is your hospital C-Suite listening to your concerns?
Let me know. I'm concerned. I'm listening.
Note: You can sign up to receive HealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.
Heart device maker St. Jude Medical Inc. and hospitals in Ohio, Minnesota, and Kentucky have paid the United States $3.8 million to settle whistleblower false claim allegations that St. Jude paid the hospitals kickbacks to secure heart-device business, the Justice Department announced.
St. Jude Medical Inc., based in St. Paul, MN, will pay $3.7 million. Parma Community General Hospital, in Parma, OH, will pay $40,000; and Norton Healthcare in Louisville, KY, will pay $133,300.
Federal prosecutors said in a media release that the kickbacks included alleged retroactive rebates that were paid based on a hospital's previous purchases of St. Jude heart-device equipment, and rebates that St. Jude paid for purchases of heart-device equipment sold by its competitors to induce future purchases of similar equipment from St. Jude.
"Hospitals should base their purchasing decisions on what is in the best interests of their patients," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "We will act aggressively to ensure that choices about healthcare are not tainted by illegal kickbacks.”
Calls to St. Jude Medical Inc. and Parma were not immediately returned Friday afternoon.
The settlement was initiated by whistleblower Jerry Hudson, who will receive $640,050.
Norton Healthcare issued a statement late Friday from Chief Legal Officer Robert Azar, which stated the following:
"As a result of its involvement in pending litigation not involving Norton Healthcare, the federal government identified customer rebate programs from a medical device manufacturer that were determined to be problematic.
"Norton participated in one of these rebate programs for a year beginning in 2003. When the federal government brought this matter to our attention last year, we opted to voluntarily resolve the issue through settlement rather than the possibility of litigation.
"Norton Healthcare has no other similar vendor arrangements and has now satisfactorily concluded this matter without acknowledging any inappropriate internal business practices."
The passage of healthcare reform that could potentially funnel 30 million new people into an already-packed system has some groups warning that the nation will soon see a shortage of doctors. The Assn. of American Medical Colleges has warned of a deficiency of up to 125,000 doctors by 2025. The Health Resources and Services Administration has projected that the supply of primary-care physicians will be adequate through 2020, at which point there will be a deficit of 65,560 physicians. All this, the groups warn, could bring longer wait times and travel distances to see a doctor, briefer visits, higher costs and—in places where shortages are extreme—loss of access to physicians altogether, the Los Angeles Times reports.
Florida Hospital and parent Adventist Health System have signed a letter of intent to lease and manage the 112-bed Bert Fish Medical Center in New Smyrna Beach on July 1, with an option to buy the facility in 2015.
The deal, valued at $77 million, was approved last week by commissioners for the South East Volusia Hospital District, and it will make Bert Fish—a safety net hospital—the fifth Florida Hospital in Volusia County, Bert Fish officials said in a media release.
Mike Schultz, president of the Florida Hospitals in Volusia and Flagler Counties, said Adventist Health System will provide $24 million in capital improvements for Bert Fish in the next five years, pay off the hospital’s debt, and fund a pension plan, for a total investment of almost $77 million.
"We are excited by the opportunity to bring our faith-based mission of healthcare closer to the residents of southeast Volusia," Schultz said in the media release. "We will build upon all the great things already accomplished by the good people here, continue their improvements in patient care and, along the way, help reduce the tax burden for the citizens."
As a part of Florida Hospital, Bert Fish Medical Center would improve access to medical specialties, such as cardiology, oncology, and surgical services, Schultz said.
Adventist Health System is the largest not-for-profit Protestant health system in the nation, with 37 hospitals, including 17 Florida Hospitals.
Hospitals shed 3,300 jobs in May, even as the larger healthcare sector created 8,000 jobs, according to Bureau of Labor Statistics preliminary data released this morning.
May's setback marks the first month of job losses for hospitals since April 2009, when the sector shed 1,000 jobs, BLS data show.
Overall, the economy created 431,000 new jobs, largely with the temporary hiring of 411,000 census workers. The national jobless rate edged down slightly to 9.7% in May—the same rate as the first three months of 2010—as the private sector reported 41,000 new jobs, and 495,000 new jobs so far this year, preliminary BLS figures show.
Job growth in healthcare continues to be powered by ambulatory services, which accounted for 8,700 payroll additions in May, 8,200 payroll additions in April, and 55,100 new jobs so far in 2010. Nursing and residential care facilities reported 2,600 payroll additions, and physicians' offices reported 2,500 payroll additions.
The healthcare sector has been one of the few areas of job growth during the recession and sputtering recovery, creating 85,000 new jobs so far in 2010, including13,500 jobs at hospitals. Healthcare created 228,700 jobs in 2009, and 618,700 jobs since the recession began in December 2007. For the past year, healthcare employment has grown by an average of 20,000 jobs a month, BLS figures show.
Overall, 15 million people were unemployed in the United States in May, and 6.8 million of them were long-term unemployed who'd been without a job for at least 27 weeks, BLS reports.
BLS information from April and May is considered preliminary and may be revised.
Cleveland Clinic today broke ground on a $25 million community health center in East Cleveland that the health system says will link healthcare with social and financial services.
The three-story, 50,000-square-foot Huron Community Health Center will be located on the campus of Huron Hospital and will open in late 2011, Cleveland Clinic said.
"In this new center, we are creating something bigger than a doctor's office; we are building a medical home," said David Bronson, MD, president of Cleveland Clinic Regional Hospital. "It will help patients learn how to both prevent and manage their diseases, access the latest in medical technology and stay connected to their physicians so they can take better control of their health."
The center will generate more than 30 new jobs and Cleveland Clinic said it hopes to hire 20% of the workforce from East Cleveland and Cleveland. The center's outpatient services will include primary and specialty care, specialized care for women and children, mental health services, and prevention, wellness, and health education programs. The center will emphasize chronic disease management, especially for diabetes, hypertension, and kidney failure.
The center will feature "patient navigators" who help patients assess, engage, and coordinate their medical, social service and financial needs, and link them to the appropriate resources. Patient navigators will coordinate healthcare services, ensure timely treatment and follow-ups, arrange for transportation to and from the center, help with complex financial and eligibility forms, and provide information about treatment options and preventive behaviors.
The Center will also include an "Iron Chef" teaching kitchen to teach patients to cook healthy, inexpensive meals, meeting rooms for community programming, a full-service pharmacy, and a 21-bed dialysis unit.
"We're strengthening collaborations with local social service agencies to build on what we've already developed and enhance the care delivered to patients with chronic diseases," said A. Gus Kious, MD, president of Huron Hospital. "Services at the Huron Community Health Center will target health needs, like diabetes, kidney disease and high blood pressure that are prevalent in the East Cleveland and the surrounding area. Our goal is to help every person succeed in managing their illnesses so we can keep people out of the hospital."
Collaborators in the project include: Northeast Ohio Neighborhood Health Services, a network of six community health centers that provide primary care and ancillary services; East Cleveland Neighborhood Center; and East Cleveland Public Library, which houses the Huron Hospital Minority Health Resource Center.
Online job ads for healthcare practitioners, technicians, and support staff fell by 82,800 listings in May for a total of 540,400 listings, ending six months of steady growth, reports The Conference Board Help Wanted OnLine Data Series.
The report, which tracks more than 1,000 online job boards across the United States, attributed the May drop to decreases in demand for physical and occupational therapists, RNs, and speech pathologists. Demand for healthcare support occupations fell by 16,600 listings in May to 111,800, reflecting a drop in demand for physical and occupational therapist assistants, nursing aids, and medical assistants.
Demand in the healthcare labor market varies substantially from the higher-paying practitioner and technical jobs to the lower-paying support occupations.
In April, using the latest figures available, advertised vacancies for healthcare practitioners or technical occupations outnumbered the unemployed looking for work in this field by nearly 3 to 1, and the average wage in these occupations is $33.51 per hour, the report said. The average wage for healthcare support occupations is $12.84 per hour and there were more than two unemployed people looking for work in the field for every advertised vacancy, the report said.
Overall, online job ads in most employment sectors across the economy—in most parts of the nation—remained flat in May with 4.1 million job listings reported for the month. The lull ends a six-month surging of more than 750,000 new job listings, the report said.
The Idaho Orthopaedic Society, an orthopedic practice group, and five orthopedists have agreed to end a collusive scheme to drive up physicians' fees that relied on a boycott of care for injured workers, the Department of Justice announced.
"The orthopedists who participated in these group boycotts denied medical care to Idaho workers and caused higher prices for orthopedic services," said Christine Varney, assistant attorney general in DOJ's Antitrust Division. "(This) action seeks to prevent the recurrence of these illegal acts and protects Idaho consumers by promoting competition in the healthcare industry."
DOJ said the orthopedists agreed to coordinate their actions, including denying medical care to injured workers and threatening to withdraw from healthcare plans offered by Blue Cross of Idaho. As a result of these actions, DOJ said the physicians caused the state of Idaho and other healthcare consumers to pay higher fees for orthopedic services.
Named in the civil antitrust suit were: Idaho Orthopaedic Society, Idaho Sports Medicine Institute, and five orthopedists: Timothy Doerr, Jeffrey Hessing, John Kloss, David Lamey, and Troy Watkins. DOJ and the Idaho AG's office also filed a proposed settlement that, if approved by the court, would resolve the lawsuit.
A call on Tuesday to an attorney representing several of the physicians was not immediately returned.
DOJ said the orthopedists engaged in two antitrust conspiracies from 2006 to 2008. In the first conspiracy the orthopedists met and agreed not to treat most patients covered by workers' compensation insurance. They launched the boycott to force the Idaho Industrial Commission to increase the rates paid to orthopedists for treating injured workers. The boycott created a shortage of orthopedists willing to treat workers' compensation patients, causing higher rates for orthopedic services.
In the second conspiracy, all of the defendants, except David Lamey, and other conspiring orthopedists threatened to terminate their contracts with Blue Cross of Idaho to force the insurer to offer better contract terms.
Blue Cross of Idaho spokesman Stewart Johnson said holding down costs is a critical responsibility for health insurers when negotiating payments for services. "We operate in good faith when we negotiate with providers and we were disappointed to learn of the allegations raised by the Department of Justice's Antitrust Division and the Idaho Attorney General's office," Johnson said. The proposed settlement prevents the Idaho Orthopaedic Society and the orthopedists from agreeing with their competitors on fees and contract terms, and also prohibits them from collectively denying medical care to patients, refusing to deal with any payer, or threatening to terminate contracts with any payer.
