Health Care: Who is going to pay?

I have been following Paul Levy's work through articles, his blog and his Twitter account. Paul Levy is the President & CEO of Beth Israel Deaconess Medical Center in Boston Mass, a teaching hospital of Harvard Medical school.


This man is going against status quo in a good way and I like that. It takes guts and not being liked. But that's okay. He has many friends, and I am one of them. For instance, he published the central line infection rates at his hospital for the public to see. I like that that philosophy. Transparency makes for greater accountability. Improved accountability will infuse action to issues that weren't being addressed before.


As more and more discussion come to the surface during our crisis with Health Care reform and financial recession, we need new processes, new ideas. New money isn't always the most effective way to improve efficiency in a hospitals state of operation. Making public your hospital acquired infection rates will certainly help improve care and reduce costs. You don't think nursing and providers will be paying attention to the fact that their patient care, or lack of, is being scrutinized? Think again. If we can get our health care providers to reduce Hospital Acquired Infections we can safe millions of dollars a year. One hospitalize acquired infection can cost up to $70,000.

Improved care doesn't need to cost us money.

If you are a health care provider or worker I hope you find a small way in your work or organization to make a difference. It could be you in that hospital bed depending on someone else to recognize the importance of improving their workflow processes and being able to own their improved actions.

Best regards.

Catalog

The word on the street is the EMR order catalog will be frozen in June. This is in preparation for upload of Cerner 2007.16 code. Actually, the upload has begun. We are going through each individual order for the catalog to spit polish inaccuracies and errors. The med and radiology catalogs are the worse. We should have a solid catalog for go live which I anticipate next year, perhaps March.

These orders are the orders your doctor would write/enter for you if you were at UHC getting care. Anyway, I am behind in all the work I need to get done, so off to Powerchart and Excel file.....

I live with my laptop 24/7.

Cynicism and Truth

http://histalk.blog-city.com/monday_morning_update_21207.htm

I like the website where all can speak freely for good or bad.
It's inevitable in this industry, Healthcare weds IT, to let ideas/feelings slip off your tongue.

Pending, pending, pending

I hate the waiting, the pending status of CPOE. I want the second implementation to go through an exhaustive check and balance process. We will need strong systematic direction. My hopes for that are high. There is a new CIO whom came from Denver. His name is Jim Turnbull. Let's see if Mr Turnbull can turn this train on it's tracks and be the direction and exhaustivly compulsive conductor we need. Always remember, it IS about the patient!

Seems Turnbull moves around alot. A man who is hard to please? Maybe that's a good thing, or not? Time will tell:

"I left the organization in 1991 and then ended up working for an outsourcing company that has since disappeared, moved to Cincinnati, and worked as a director of IT at one of the suburban hospitals there. Then, ultimately became the CIO for the four suburban hospitals who were part of the system. The whole consulting company crashed. At about that time, the CIO that I worked with in Portland, Jim Turnbull, had since moved down here to Florida and there was a Director of IT position. So I moved down here in 1995. I was the Director of IS for five years. Jim left in 2000 to go to Denver Children’s. I was promoted to CIO." by Denis Baker.

http://histalk2.com/?s=turnbull

HOE-Short for whoring of orders

I can't believe it. They are considering having our Health Unit Coordinator, HUC's, transcribe the paper order into the electronic ordering system that would have been, Computerized PROVIDER Order Entry, CPOE. It is a ludicrous plan in my clinical judgement and could not and should not be called CPOE. Order entry by anyone other then the provider is a "basterdized" CPOE process.




http://www.healthimaging.com/content/view/8530/68/

Computerized physician order entry (CPOE) isn’t a quick fix to improve efficiency, workflow and quality patient care. On the contrary, it requires a fairly technologically sophisticated facility and an exhaustive implementation process. But the benefits of adding CPOE are clear and compelling. Two facilities share their experiences in implementing CPOE.

Once she realized how much written orders delay patient care, Angela Nicholas, MD, chief medical information officer at Susquehanna Health System in Williamsport, Pa., was on board with CPOE. It may take less than two minutes for a physician to open a chart and write an order. However, the chart doesn’t get transcribed immediately. The physician probably has it for another 15 minutes or so and then the chart goes to the unit clerk. There’s no guarantee that the unit clerk will address charts with a first-in, first-out policy, which can add up to a significant delay in patient care. “It was very eye-opening to me,” says Nicholas.

She also found that unit clerks and nurses do a lot of interpretation of orders. Physicians order tests that aren’t even conducted anymore or the terminology is outdated. “So, the unit clerk is now trying to figure out the test the doctor really wanted to order,” says Nicholas. “With CPOE, that isn’t an option. Physicians will order exactly what they want.” Imbedded best practices and protocols pave the way.

Welcome to Lost

Everyone from IT, to nursing to u-name-it are feeling a variety of emotions: paranoid, anxious, depressed, overjoyed, angry, bewildered, lost......

All because of 3 years or more of preparation for CPOE and ka-boom!.....postponment just 2 days before golive! I think it slowly sinking in what a big deal this is. Not to mention the money.

Now, there is no direction, not yet at least. The new CIO of IT, Trumbull, is due to start his new job March 24. Welcome to chaos.

I just think we need to throw out the bath water and the baby. Someone should be admonmished for not have a sound redundant system in place. Geez!

Downtime

The U Hospital made a decision 2 days before our CPOE conversion to stop the train. It was stopped just before crossing the bridge. It appears that the IT infrastructure track has no redundancy plan. This blogger admits to anger for IT not being ready to prevent all the database from crashing at once. Their security, planning is ludicrous.

Stopping the CPOE conversion is a huge deal. It is going to cost the hospital money, big dollars and we already are losing millions each year from reimbursement funds (medicaid/medicare). We are a state facility.

I am so angry, I have to pause for now.....

Drawing

We're All In This Together

A happy little ditty by Ben Lee

The Waiting is Over

On June 2nd, we converted to electronic Nursing documentation. Next conversion is CPOE and the interfaced ancillary documentation. That's the bigger beast.

For now, we are soothing the sores felt by the change, the loss of paper, the bumps and bruises and the hours it takes to chart. They say it will get better. I believe that, but do they, the bedside nurses? They will come to see it, but they need all the comfort, honesty and encouragement they can get. I hate having to say, "hang in there". That seems so cheap when the nurses are almost slaving to care for highly ill patients in this grand nursing shortage of our generation. Computers just don't seem as important and they are..... so..... discompassionate and cold.

Dear Nurse......Hang in there!