Quality and Safety

New measures could save hospitals up to $284 million annually, officials say.

Vows to lobby Congress for comprehensive action on the issue, calls for lift of 20-year ban on CDC research on gun violence.

Mosquitoes bearing Zika — a virus that can cause birth defects when contracted by pregnant women — are expected to reach the United States as soon as this summer, with Florida and Texas likely to be among the hardest-hit states. But in both, support for women’s health care, along with family planning resources, has been dramatically scaled back, in part because of funding restrictions placed on women’s clinics that, in addition to other services, provide abortions. Also, both states declined to expand Medicaid. Those decisions, many advocates say, are putting a squeeze on the health care system’s ability to educate women about Zika’s risks and minimize its impact. “The ways to prevent it are to either, one, not be pregnant and, number two, if someone is pregnant, avoid exposure — which I think can be more challenging,” said Anthony Ogburn, chairman of the department of obstetrics and gynecology at the University of Texas-Rio Grande Valley School of Medicine in Harlingen. Texas and Florida are advancing prevention plans that emphasize mosquito surveillance and targeted spraying. Some public health campaigns also have been launched to raise awareness, but funding is limited. Neither state’s legislature has provided specific funding for those initiatives and neither is scheduled to meet again until after mosquito season. And those campaigns miss a key element, advocates say, given the heightened stakes for pregnant women. The states aren’t addressing the challenge low-income women face in getting birth control. And, for those who do get pregnant, there are still major barriers to accessing potentially helpful prenatal care. “No amount of mosquito repellent is going to get us out of this,” said Christine Curry, an assistant professor of obstetrics and gynecology at the University of Miami Miller Medical School. For most people visibly affected, Zika’s symptoms are comparable to at worst a bad flu, plus maybe a rash. Although much less common, it also has been connected to Guillain-Barre, an autoimmune disorder that causes weakness, temporary paralysis and, in rarer cases, permanent nerve damage or death. But for pregnant women, the virus can cause severe birth defects like microcephaly, which impairs brain development, or loss of the pregnancy altogether. That underscores the need to ensure women of child-bearing age know the risks and protect themselves. In Florida, the state health department is sending out multiple updates each week to anyone who’s expressed interest — “media and community partners,” mostly, said Mara Gambineri, a department spokeswoman. These updates note confirmed cases and strategies to avoid mosquito bites. It’s also put up billboards and distributed educational door-hangers for residents of high-risk areas and infographics for doctors. Similarly, Texas is launching a media blitz, using venues like local radio, social media and ad buys to talk about prevention. Outreach is in English and Spanish. The state is leaning on local governments and health departments to help with prevention efforts, said Carrie Williams, a spokeswoman for the state’s Department of State Health Services. Congress has debated allocating emergency funding, but its progress has been slow. The Centers for Disease Control and Prevention has indicated that, if additional dollars are provided, it would use some of that money to support such state activities. The federal government has said states can use Medicaid dollars to help with Zika prevention, covering services from purchasing mosquito repellent to family planning. But Texas still “is reviewing” that proposal and how Medicaid could fund the Zika fight, said Bryan Black, a spokesman for the state’s health and human services commission. In Florida, Medicaid plans are encouraged to cover repellent, said Shelisha Coleman, a spokeswoman for the state’s Agency for Health Care Administration. But Medicaid eligibility is tight in both states, so even that added benefit skips over a fair number of women. Since neither Florida nor Texas opted into the health law’s Medicaid expansion, these women fall into a so-called “coverage gap.” They are too poor for subsidies to buy insurance on the exchange but too wealthy for the low-income health insurance program. Since they don’t have coverage, family planning and prenatal care can be cost-prohibitive or difficult to get, so they may have limited access to health providers who could help with taking precautions against the virus. That makes outreach efforts now, early in the season, critical. While people are hearing about Zika, it hasn’t yet triggered the level of action that drives women to see the doctor, said Linda Sutherland, executive director of Healthy Start Coalition of Orange County, a Florida nonprofit clinic that focuses on child and maternal health. In Florida, the uninsured can visit a community health center, or a clinic run by the state health department, Sutherland said. If Florida sees Zika transmission, and patients get worried — so there’s “an avalanche of people” trying to avoid pregnancy — she doesn’t think there are enough affordable family planning facilities to meet that demand. And state clinics have seen budget cuts in the past several years, meaning they are smaller and less likely to offer comprehensive prenatal care. As a result, “it is a daily occurrence that someone who has lived in this state her entire pregnancy presents for delivery having not interfaced with the public health system,” said Curry, who also sees patients at Jackson Memorial Hospital, in Miami. Those services take on new importance now, in addressing the Zika virus, she added. “These are huge opportunities for preventive care.” Texas has made it easier for pregnant women to enroll in Medicaid, which can cover services like prenatal care, said Melissa McChesney, outreach coordinator at the Center for Public Policy Priorities, a left-leaning Texas think tank. Most women do get some kind of check-up before giving birth, but getting care as early as medically wise is another question. About 40 percent of pregnant women won’t see a doctor in their first trimester. That’s likely in part because of challenges like not knowing how to pay for it or lacking experience navigating the health care system, McChesney said. Improving on-time access to prenatal care is “a top priority in Texas” — especially given the Zika threat, said Black of the state’s health and human services commission. Community health centers in both states are trying to help educate women of child-bearing age. The women relying on these clinics are often among “the poorest of the poor,” said Jose Camacho, executive director and general counsel for the Texas Association of Community Health Centers. They might live in housing that lacks air-conditioning, or that allows easy mosquito entry. Or they may not have the money for repellent or preventive clothing. “We’re extremely concerned that health centers, because of the housing and conditions around the housing that our patients live in, are going to start seeing quite a few of the Zika patients,” Camacho said. Providers at those clinics are trying to advise women at risk — telling them to avoid standing water and repair mosquito netting around their houses, Camacho said. But for many, getting to the clinic is even a challenge. Transportation is a barrier. And it can take weeks to get an appointment. And if clinicians hope to reach women, they really should visit them at home, Camacho said. That requires manpower, time and money. All are in short supply. Most states rely on information pamphlets produced by the CDC, he added. And those are available in English and Spanish, but many patients also speak other languages. “Are the proper things being funded that help at the local level? I’d have to say no,” he said. “And the communities our patients reside in are usually the last ones to get the attention.” This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The goal is to rapidly design, develop, prototype, and showcase new healthcare solutions.

Omicia to expand HIPAA-compliant, cloud-enabled platform for research, population health, clinical trials.

CHIME has named two winners of the "Concept Blitz Round" of the National Patient ID Challenge it launched with HeroX, selected from an initial round of eight finalists. A panel of five independent judges first narrowed the initial 113 entrants down to 23 semifinalists and then eight finalists. Of those, Michael Braithwaite, who has devised a scalable strategy that uses enhanced biometric information to match patients with their unique health data, and Mark Schroeder, who proposes to deploy HL7-approved standards to enable demographics and biometrics for patient ID – came out on top. Both won $30,000. The other six finalists were: Shawnnah Castillo; Kathryn Elaine; Bon Sy and Ayman Zeidan; and teams from Mathematica Policy Research, Spiral Nebula and RightPatient. Launched in January, the CHIME/HeroX challenge seeks innovative ways to help U.S. providers reliably, accurately, privately and safely identify patients. Speaking at HIMSS16 in Las Vegas this March, CHIME Board Chair Marc Probst, CIO at Intermountain Healthcare, called the lack of a dependable patient ID a "vexing problem" for healthcare with adverse effects on cost, efficiency, quality and safety. "Done right, a national patient ID will save lives," he said. [Also: ONC awards Boston Children's Hospital $275,000 to work on EHR apps discovery site] In a June 1 press statement, Probst said he was encouraged and excited by some of the innovative projects submitted to the Concept Blitz Round, with so many leveraging technology that already exists and won’t require wholesale disruption of today’s IT systems. That's critical to finding a tool that can be deployed across healthcare organizations of varying sizes and providers types, he said. "As patients increasingly seek care across the continuum, and data moves from one care setting to another, it is vital that we ensure patients are accurately identified and matched to their records." The patient ID challenge now moves into the Final Innovation Round – open from June 1 to November 10. Innovators were not required to take part in the Concept Blitz Round in order to enter the final round, but must register by July 12 to be eligible for the $1 million prize. With Johns Hopkins recently pointing to medical errors as the third leading cause of death in the U.S., the stakes are higher than ever for accurate patient matching, CHIME CEO Russ Branzell said in a statement. "We know that somewhere, right now, a patient is being harmed due to misidentification," he said. "We owe it to our patients to solve this problem once and for all. The solutions coming forward in this challenge are pointing us to a real solution." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

The plaintiff, known only as M.P.B., alleges that Theranos Edison machine produced results that were not accurate. 

Patrick Conway, MD, Chief Medical Officer of the Centers for Medicare and Medicaid Services said the networks will advance systemic use of proven practices on a national scale. 

By Michelle Andrews, Kaiser Health News In his recent book, “The Finest Traditions of My Calling,” Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences. Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and practices on the adult inpatient psychiatric unit there. I recently spoke with him and this is an edited transcript of our conversation. Q. Your book is in some ways a lament for times gone by, when physicians were “artisans” who had more time for their patients and professional independence. But you’re a young doctor and you must have known at the outset that wasn’t the way medicine worked anymore. Why do you stick with it? A. The first thing I’d say was that I didn’t know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling. Q. You don’t like checklists and quality improvement measures that dictate how physicians care for patients because you say it turns doctors into technicians and is an obstacle to “moral reasoning.” But those tools, which generally take a systems approach to providing care and rely on evidence-based guidelines, aren’t going away anytime soon. How do you do the kind of doctoring you want to do in this environment? A. Quality improvement seems to be here to stay. Regulators at all levels require it. But I believe that evidence of its success is not as clear as they suggest. Just last week, the British Medical Journal published a study that found no evidence that introducing quality metrics has resulted in a significant reduction in patient mortality. The leaders of the quality movement’s version of quality improvement developed out of industrial engineering, so they are always comparing the care of patients to things like the production of cars or the flying of airplanes. People are far more varied than cars on assembly line or planes on the runway. So quality metrics always feel forced to me, especially for the more interactive medical encounters. In my own specialty, the current quality metrics all encourage me to perform standardized screens on patients or to document carefully. None of them require me to develop a relationship with a patient so that I can, say, foster hope after a suicide attempt, or knit a psychotic person back into the life of their family. Yet that it was my patients want, those human relationships. It is also what physicians want, and the most recent studies suggest that most physicians are dispirited by quality metrics. Q. But not all physicians are equally skilled or conscientious. As a patient, I feel more comfortable knowing there are rules and standards that doctors have to meet. A. I don’t think physicians should be free to do whatever they want. Their thinking and decision-making should be held up to scrutiny. A physician’s standard of quality should be evidence-based, but even more, it should be patient-centered. The standard should be what the patient defines as what matters. So if you are suffering chronic pain, it is not just a reduction of your score on a standardized pain scale, but your ability to resume the activities you identify as constitutive of your life. Q. You talk about wanting to be able to sit with patients and talk with them, to really “see” them. All that takes time that physicians don’t generally have. I understand your book isn’t a how-to manual. But, really, how can physicians do this, even if they want to? A. It’s a real challenge. It’s important to use the time you have in service of the patient’s needs. I don’t review records while I’m in the room with a patient. I try to make every question be about the patient. I have to ask standard questions, but I try to do that as way to get to know the patient. For example, if I have to ask questions about what they can remember, I’d ask about a book they have with them. Part of my concern about checklists is that they train you to follow a script instead of following your patients. Q. Only 55 percent of psychiatrists take insurance compared with nearly 90 percent of physicians in other specialties. That puts their services out of financial reach for many people who could use their help. How does that square with your vision of doctors as healers and teachers? A. It’s deeply concerning to me. I’ve made a conscious choice to work at a safety net hospital, so I can see people regardless of their ability to pay. I hope that through things like the Medicaid expansion and mental health parity, more psychiatrists will work with people who have mental illness. Q. You talk about the virtues of “slow” medicine, similar to the slow food movement, where physicians reject providing care in a standardized, mass-produced fashion. One path that some physicians have chosen is to establish boutique practices that accept a limited number of patients who pay extra fees for more personal attention and better access. What’s your perspective on that? A. It sounds appealing to me. In most descriptions of boutique medicine, they talk about it like a lovely restaurant, one that I couldn’t afford to go to every night. I think it’s an interesting model but not a solution to the large problems facing medicine, in particular the ability to provide care to the most needy among us and the indigent. This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.    

In a $36 million contract with Philips, the hospital system is working to improve the collection and management of patient data to standardize clinical practices and enable interoperability with other systems.