Category: Uncategorized

Patient-Centered Medical Home & the Cloud

Posted on by Greg Dennis

We’ve been told for awhile that there’s a big change coming in how healthcare is delivered and paid for.

Update: The transformation is here, and it places a premium on efficient sharing of healthcare information.

That’s the word from Paul Grundy, M.D., MPH, a presenter at the 2012 CHIME/HIMSS CIO Forum in February. Grundy, who is president of the Patient-Centered Primary Care Collaborative and director of healthcare transformation at IBM, pointed to the growing percentage of healthcare that is now delivered via the patient-centered medical home (PCMH) model – and also the growing share of payments from private and government payers now going to PCMHs.

A PCMH is a team of providers led by a personal physician who coordinates the patient’s care with various sub-specialists. As Grundy noted, no one provider in a PCMH completely owns patients or their data, so data has to be shared with all relevant team members – smoothly, quickly, and reliably.

Cloud-based medical info exchange has a role to play in this process. Where imaging files are concerned, no method better fits the PCMH scenario than a cloud-based service like eMix that almost instantly moves medical files and reports to any provider’s Web-connected computer, including tablets and smart phones.

Moreover, today’s Facebooking, tweeting patients expect new types of interactions with their providers, including virtual interactions.

As one sign that medical manufacturers have already geared up for this new reality, consider VGo, a new, remote-controlled “telepresence” robot that, among other uses, enables providers to see and interact with patients as if they were in the same room.

To understand the growing potential of patient-centered medical homes, just follow the money.

Two large private payers, WellPoint and UnitedHealthCare, are redoing their reimbursement and delivery approaches. On the government side, the Centers for Medicare & Medicaid Services (CMS) has committed 11 percent of payments to approaches other than fee-for-service. This redirection of payments will drive more and more providers to adopt the PCMH model, Grundy said.

Why the sudden shift? It’s in part because payers are fed up with the inefficiencies of a healthcare system too heavily reliant on unregulated fee-for-service and rescue/specialty care, Grundy said.

The goal of the PCMH is to improve outcomes and reduce costs through coordinated care. Grundy described several studies showing that the PCMHs studied were already resulting in fewer hospital readmissions and shorter hospital stays.

What does it all mean? A new model of healthcare and provider compensation is here to stay. At the same time, robots at patients’ bedsides and imaging files shared via the cloud are carving a place for themselves in contemporary healthcare. The convergence of these new arrivals could be beneficial for all parties.

Cloud-Based Medical Data Exchange at Virtual HIMSS

Posted on by Greg Dennis

Exchanging medical information in the cloud is getting more attention these days, as its patient-safety and economic advantages become more apparent.

Among the leaders in this field is eMix, a client of ours. Florent Saint-Clair, eMix general manager, recently led an On-Demand Education Session of Virtual HIMSS12 titled “Cloud-Based Medical Data Exchange: What We’ve Learned So Far.” Virtual HIMSS 12 was held online from Feb. 20-24. To see Saint-Clair’s post on the HIMMS blog, click here.

HIMSS provided the virtual sessions as a way to take part in activities related to the HIMSS 2012 Annual Conference & Exhibition, other than attending the event in person. Attendees were able to participate from any location in the world. Virtual HIMSS12 included both interactive activities and on-demand sessions such as the one on cloud-based medical data exchange.

Saint-Clair’s session described the evolution of cloud-based medical data exchange from its introduction in 2010 to its increasingly wide use today. He discussed why the technology is a giant leap forward from such troublesome, limited workaround solutions as exchanging files on CDs and sending them via virtual private networks (VPNs).

CD and VPN file exchanges are plagued by such issues as time delays, reliability, and security. Cloud-based medical data exchange has created a sharp, and welcome, break with this troubled past. Thanks to the new technology, a hospital can now securely send an imaging or other medical file to a radiologist’s EHR, PACS, or mobile device – indeed, any computer with a broadband connection – in just minutes.

The technology is similar to using email and just as reliable. It is also vender-neutral, which means it neatly hurdles the fact that medical information technology systems are often proprietary and don’t easily “talk to” each other. This was the problem that created workarounds such as CD- and VPN-mediated file exchanges in the first place.

Saint Clair’s presentation detailed the various ways that patient care has been improved by the increased reliability and speed brought about by services like eMix. He also noted the adjustments that adopters of the services face with respect to their workflow, protocols for handling images, and business processes. For those who couldn’t make it to HIMSS, the session provided an opportunity to get updated on an important new advance in medical data exchange with the depth and sophistication that HIMSS attendees expect.

Breast Cancer Media Teleconference

Posted on by Greg Dennis

Shortcomings of the New Study on Breast Cancer Brachytherapy (APBI): What Women Need to Know Now

On December 13, 2011, four of the world’s leading clinical researchers in breast brachytherapy gathered to provide statements and discuss a controversial new study on APBI presented at the 2011 San Antonio Breast Cancer Symposium.

Featuring:
• Robert Kuske, MD, (Scottsdale, AZ) Co-Principal Investigator, NSABP B-39 study comparing five-day APBI to six-week whole breast irradiation
• Peter D. Beitsch, MD, FACS, (Dallas, TX) Co-Principal Investigator of the American Society of Breast Surgeons’ MammoSite Registry
• Jayant Vaidya, MD, (London, U.K.), pioneer of targeted intraoperative radiotherapy (IORT)
• Rakesh Patel, MD, (Pleasanton, CA), Chairman, American Brachytherapy Society

Stream audio of teleconference

Background:
The study was based on Medicare billing claims for more than 130,000 patients over the age of 66 who were diagnosed with early stage breast cancer between 2000 and 2007 and received a lumpectomy and radiation.

Many members of the medical community have spoken out against the study since it was presented. In particular, many physicians object to mastectomy being considered a validated surrogate for local failure, contending that there are many indications for mastectomy unrelated to APBI, such as a new primary cancer or elsewhere failure, and that claims data do not provide sufficient clinical information to draw such conclusions. In addition, the study claimed brachytherapy was associated with higher rates of infection and increased toxicity which is contrary to results of several published clinical trials on brachytherapy.

Read statements of concern from the major medical societies involved in the research and use of APBI – American Society of Breast Surgeons, American Brachytherapy Society (PDF) and American Society of Radiation Oncology.

Video: Study on preventing IV Bloodstream Infections

Posted on by Greg Dennis

Dr. Gregory Schears (Rochester, Minn.) outlines his 12-hospital research on IV disinfection cap to reduce deadly infections.

Cloud-Based Medical Info: ONC, Feds Miss the Obvious

Posted on by Greg Dennis

The federal Office of the National Coordinator for Health IT (ONC) has developed a Federal IT Strategic Plan aimed at reducing IT disparities between underserved communities. ONC published a draft of the plan in an online blog and is now seeking comments and suggestions.

We have one suggestion: Promote widespread adoption of cloud-based medical information exchange.

While the plan refers to telemedicine in general as one way to improve the usage of healthcare IT, there is no evidence the ONC recognizes that this long-used term should now include cloud-based data exchange. Nor is there any recognition of the superiority of cloud-based services for meeting the plan’s other goals.

Three of those goals are:

• Achieve adoption and information exchange through meaningful use of health IT

• Improve care, improve population health and reduce healthcare costs through the use of health IT

• Inspire confidence and trust in health IT

Cloud-based medical information exchange advances these goals in many ways.

Because it is vendor-neutral, it overcomes incompatibilities between different facilities’ IT systems –not just in underserved communities but also in the common scenarios where a rural facility is transferring patients with complex conditions to better-equipped institutions outside the community. Here is an example of just such a set-up in the San Diego area, where eMix has made a big difference: http://bit.ly/g5Umvq

The modest, per-usage fee for using a service like eMix also makes it affordable and scalable for underserved communities. No software or hardware purchase is required. Nor is there a maintenance contract because maintenance is the service provider’s responsibility.

Cloud services reduce costs in other ways, too – by avoiding the substantial labor associated with virtual private networks and the labor, postage, and courier costs associated with burning and sending files on CDs.

Cloud-based medical information exchange improves care, as well, because it is a much faster way of getting medical files in the hands of the physicians who need to see them. This is especially true for emergency cases.

Finally, cloud-based exchange inspires confidence and trust in health IT because it ends the frustration that until recently characterized most efforts to exchange files between IT systems. Until recently, sharing files between systems that didn’t talk to each other was labor-intensive, expensive, and loaded with breakdown potential.

Those days are over – but only for the institutions that are taking advantage of the technology.

If the ONC is serious about its goals, then it should be promoting this simple-to-adopt, simple-to-use solution in its strategic plan.

Dr. Attai Leads the Way on Social Media for MD’s

Posted on by Greg Dennis

Fully half of Americans now participate in social media — and the impact of Twitter, YouTube, Facebook and other new media is growing every day.

Given those numbers, it’s especially surprising that there are very few doctors who take part in social media.

One happy exception to that rule is Deanna Attai, M.D. a noted breast surgeon and head of the Center for Breast Care, in Burbank, Calif. She’s proof that even a very busy doctor can find time to be online.

Like many MD’s, Dr. Attai has a website (http://www.cfbci.com). But her online presence extends well beyond that.

She participates daily on Twitter (@drattai) where she has more than 750 followers. She’s on LinkedIn and has a channel on YouTube. She’s a guest blogger for the integrative medicine site http://www.morrisonhealth.com, where she recently blogged about a gluten-free diet.

“I like the ability social media gives me to reach a wider audience and do what I love to do, which is teach and educate,” she says. “I try to keep my online activities within the realm of things I would talk to my patients about,” she says.

But Dr. Attai’s realm is broader than that of many breast surgeons. Taking a more holistic approach, she’s just as likely to write about general health and wellness as she is to talk about specific breast cancer issues.

Dr. Attai is one of the pioneers in physician social media.

“It’s all about getting information out,” agrees Dr. Attai.

Not one to limit her activities to simple tweets, she’s been quick to expand the Twitter platform. For example, she’s a regular participant in the weekly, live Twitter chats about breast cancer and social media, which you can track on Twitter through “#BCSM.”

Like everyone who is active on social media, however, Dr. Attai notes that there are limits. She’s careful to keep her personal life out of her social media postings. And her medical office, where she spends at least 10 hours a day, is officially a “no twitter zone.”

Look for her social media profile to continue to grow. She firmly believes that one way to be an even better physician is to communicate online, adding: “It gives patients a way to see another side of me.”

IV Needleless Connectors and Infection Risk

Posted on by Greg Dennis

It’s an inevitable part of medicine that changes in technology have unintended consequences — and that not all of them are favorable consequences.

One example is the implementation of needleless connectors for IV catheters. Designed to protect healthcare workers against accidental needlesticks, these IV connectors are used hundreds of millions of times in the US every year.

However, the same connectors are also proving to be a source of potentially dangerous central line associated bloodstream infections (CLABSIs).

Gregory Schears, M.D., a widely published critical care specialist and the physician liaison to the PICC team at the Mayo Clinic in Rochester, Minn., spoke on this topic at a meeting earlier this summer sponsored by the Joint Commission.

The prestigious and influential Joint Commission, which is the primary accreditor of healthcare facilities in the US, built its annual conference around the theme of “Come Together: A Gathering of Leading Ideas in Quality and Safety.” Dr. Schears’ talk was titled “Needleless Connectors: Where Did We Go Wrong and How Do We Make It Right?”

He began his talk by tracing the history of needles and needle-safety technology in medicine. While needleless IV connectors are very effective at protecting healthcare workers, he said, they introduce new levels of risk to patients.

“We have gone into a series of unintended consequences where what was right for the healthcare worker now may be harmful to the patient,” he said. Safety technology has largely solved the problem of accidental needlesticks during the delivery of infusion therapy, but he added: “Our responses with needleless connectors have jeopardized patient care because of the increasing risk of infection.”

How to solve this dilemma?

Dr. Schears and others are investigating the possibility that passive technologies — such as an inexpensive, twist-on disinfection cap to protect and disinfect needleless connectors between line accesses — might be part of the solution.

“We probably need to look to passive technologies such as this to help us out,” he said. His research is exploring “the question of what we can do, to help reduce colonization and subsequent infections that are associated with needleless connectors.”

Dr. Schears will be speaking about his research, at the upcoming annual conference of the Association for Vascular Access in early October. He describes his research in a brief video on disinfection caps, which you can view as part of this blog.

INS 2011

Posted on by Greg Dennis

The annual meeting of the Infusion Nurses Society attracted hundreds of nurses from all over the  world for  its May gathering in Louisville, Ky.  With Medicare no longer reimbursing for hospital-acquired infections such as  Central-line associated bloodstream infections (CLABSI’s), nurses were especially interested in new technologies to reduce these potential deadly infections.

One of the technologies drawing considerable attention was SwabFlush, from Excelsior Medical (a Dowling & Dennis client). SwabFlush combines the SwabCap disinfection cap for needleless IV Connectors with a flush syringe. More information at www.swabflush.com.

Video of Tony Saia (VP of Global Marketing for Excelsior) demonstrating SwabFlush during INS:

Study Shows Promise of Disinfection Cap as Weapon in the War on Infections

Posted on by Greg Dennis

For years, efforts to reduce central-line associated bloodstream infection (CLABSI) rates have focused on relatively complex initiatives – including “bundles” of evidence-based practices and technologies that together create multi-layered protection against infections. Now, the early results of a prospective, peer-reviewed clinical trial suggest that the use of a simple but ingeniously designed device can contribute to improved disinfection and allow for reduced CLABSIs.

That device – SwabCap® by Excelsior Medical – is also known as a disinfection cap. SwabCap supplements manual disinfection of IV connectors, long thought to be a weak point in CLABSI prevention because the method is subject to variation and noncompliance. The study results were recently reported at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).

Early results of the prospective, peer-reviewed clinical trial demonstrated that SwabCap® improved disinfection and allowed for reduced central-line associated bloodstream infection rates of more than 79%. Those improvements were seen in the four-hospital NorthShore University HealthSystem (Evanston, Ill.) after SwabCap was implemented for use on all central lines.

Notably, the gains were made even though the hospitals already had a low rate CLABSI rate of 1.95 per 1,000 catheter days before SwabCap was tried.

NorthShore also studied the device’s effectiveness a second way: it compared the density of colony-forming units (CFUs) of bacteria in blood samples when SwabCap was used to CFUs in samples when it wasn’t. During the SwabCap phase of the research, contaminated samples were 75% less dense with bacteria.

The new data is the most extensive ever gathered on SwabCap. The device is in use at multiple institutions, sometimes allowing for a drop in infection rates that is even more dramatic than at NorthShore. More at http://www.swabcap.com.

IV Connectors: Younger Nurses May Be More Diligent Cleaners

Posted on by Greg Dennis

We often think of young people as rebels and their elders as better at following rules. But the opposite is true in American hospitals, a new study says – at least when it comes to disinfecting IV connectors.

Recent graduates of nursing school were more likely “to consistently use optimal disinfection techniques” than were more experienced nurses, according the study, in the May-June issue of the Journal of Infusion Nursing,.

The research examined whether younger or more experienced nurses adhered more closely to the “scrub-the-hub” manual method for disinfecting connectors. The method requires nurses to scrub the connector hubs with alcohol for up to 10-15 seconds and then wait up an additional 30 seconds for the alcohol to dry before accessing the line.

This protocol is widely recommended by infection control experts, but it must be performed meticulously to have any chance of being effective. The method’s several steps mean that variation is common, and busy nurses are known to sometimes skip disinfection altogether. The consequences of variation or noncompliance are great because incomplete disinfection increases the risk for sometimes deadly central line-associated bloodstream infections (CLABSIs).

The study found that nurses just out of school were more likely to perform the protocol exactly as it was taught – a good thing. The more experienced nurses, conversely, rated higher than younger nurses in such qualities as autonomy and “self-efficacy” (essentially, belief in one’s own competence). One can assume from this that more experienced nurses felt more free to stray from the protocol – not a great idea in this case and one that put patients in danger.

The findings may point toward one reason hospitals should be using a disinfection cap such as SwabCap® to supplement manual disinfection. SwabCap, from our client Excelsior Medical, is ingeniously designed to eliminate variation and noncompliance.

By prolonging the hub’s contact with alcohol, it may also increase the bacteria kill over manual methods, especially when compliance with the manual method is not optimal.

Considering what’s at stake, it seems to us that using the cap is a no-brainer – even if a nurse just graduated magna cum laude.

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