Quality and Safety

Putting patients at the center of preventing mortality from blood clots, and being more aware of them in recognizing their onset, is key to stemming the disease burden. We can do more to engage with information, tools and other patients and programs to help monitor this condition.

Iowa- and Illinois-based Genesis Health Systems has joined forces with visibility and analytics provider, STANLEY Healthcare, and nurse call platform provider, Critical Alert, to streamline clinical workflows using STANLEY'S RTLS platform and Critical Alert's Nurse Call tool, the companies announced last week.   Using the native integration from Critical Alert and the staff workflow function of STANLEY's RTLS platform, the staff at Genesis can locate clinicians and respond to bedside patient alerts and requests. Maureen Nylin, nursing clinical informatics specialist at Genesis Health System told Healthcare IT News that Genesis expects the implementation will improve HCAHPS scores and staff and patient satisfaction.   "The implementation was a collaborative approach," Nylin said. "Alarm management is a hot button issue from everyone across the board; it's getting tongue-in-cheek. It's not about managing alarms, but making sure what you're doing is meaningful."   "For our clinicians, when they're getting messages, they know exactly what the patient needs," she added. "Trying to overcome alarm fatigue is about getting the right message to the right person, at the right time."   Implementation began in June of 2015 at Genesis' DeWitt Community Hospital. According to Nylin, one of the greatest improvements is that patient calls are canceled as the nurse walks into a room, which frees up time for the clinician.   Furthermore, the data is being collected for a knowledge base to "see the low-hanging fruit," Nylin said. "We'd like to use the analytics to see where we can improve efficiencies."   The Critical Alert tool captures data from clinical workflow, allowing staff to analyze the data points into the nurse call system, according to Josh Troop, marketing director for Critical Alert.   "We're working with companies like STANLEY, to create something much more valuable than two equal parts," Troop said. "In this case, we were able to leverage the STANLEY investment that Genesis already made to ramp up our tools already. Our systems work together seamlessly in the background."   For STANLEY, it's about making sure "clinicians have more time to spend with the patient to improve the care arena," Nadav Barkaee, product manager for integrations, STANLEY Healthcare said. "One of the major benefits of being able to offer an enterprise-grade RTLS solution is to make sure the investment can be used across multiple solutions for staff efficiencies and workflow."   Genesis plans to implement the systems at four more of its hospitals in the near future.

Over the past decade, the federal government has publicized 115 different ways to measure medical quality in hospitals, from assessing wait times in emergency rooms and noise levels outside hospital rooms to tracking blood clots in surgical patients. But the latest effort, to combine dozens of metrics into one patient-friendly quality indicator, has proven the most contentious. The Centers for Medicare & Medicaid Services recently postponed its plan to release the new rating system, which would award one star to the worst-quality facilities and five stars to those with the best marks. The delay came after a majority of members of Congress signed a letter supporting the hospital industry’s concerns. Hospital leaders who previewed the preliminary rating system say the formula seems skewed against institutions that treat the poorest or toughest patients, meaning those with complex illnesses. The number of stars would be based on 64 different measures, which are posted on Medicare’s Hospital Compare website. The metrics on mortality, readmission, patient experience and patient safety are the most influential, each representing 22 percent of a facility’s rating. Steven Lipstein, president of BJC HealthCare, a St. Louis-based nonprofit that runs 14 hospitals, said the ones in his organization that earned five stars were smaller, located in affluent areas and handled less complicated cases. “They don’t have comprehensive cancer centers, they don’t have major cardiovascular disease, they don’t have neuro-specialties,” he said. BJC’s more advanced hospitals did worse, he said. “That’s not surprising when you look inside the ratings and see how they’re built,” he added. Consumer advocates defend the rating system, saying that while not perfect, it correctly reflects higher rates of problems in some big institutions despite their lofty reputations. They worry that delay and congressional resistance are undermining Medicare’s attempt to help consumers select a hospital based on something more substantive. “The star ratings hopefully will get quality into that decision-making process,” said Andrew Scholnick, a lobbyist for AARP, the advocacy group for seniors. Medicare officials initially said they hoped to release the ratings to the public in July. But in a presentation to hospitals and other interested parties last Thursday, they did not set a firm date. Medicare already has made minor tweaks in the formula to calculate the stars, but it remains a tough grader, the presentation shows. If Medicare releases the star ratings in July, nearly half of the 3,658 hospitals being evaluated would be getting three stars, according to Medicare’s preliminary calculations. Just 100 hospitals would receive five stars, while 135 would receive a single star. Officials indicated they were standing firm in their intention to eventually release the scores. “The Overall Star Rating represents a performance summary designed to facilitate patient and consumer use of Hospital Compare,” the presentation said. Officials plan to update the scores every three months through the end of this year and then twice thereafter. The broader debate about the government judging hospitals has been going on since Medicare began publishing quality ratings in 2005. But it has intensified since passage of the Affordable Care Act, which instructed Medicare to use quality metrics in setting payments. Teaching hospitals as a group have tended to fare poorly from some of these financial incentives. This year, for instance, nearly half of major teaching hospitals are losing 1 percent of their Medicare payments because of high rates of infections and surgical complications. Facilities with more low-income patients, who often face difficulties affording medication, following complicated recovery instructions and getting to doctors regularly, typically have higher readmission rates. Some health care researchers are also skeptical. “If you come out with a rating that says Cleveland Clinic is terrible but podunk hospital in North Carolina, they’re the bomb, there’s a disconnect,” said Ashish K. Jha, a professor at Harvard’s public health school. “If it completely contradicts everything you’ve known, you need to ask yourself, ‘Did I not understand the way hospital care works, or is there a problem with the metric?’” Medicare’s move toward using star ratings is part of a greater focus on easy-to-grasp composite judgments of hospital quality. The Leapfrog Group, a nonprofit patient safety group, uses report-card letter grades to characterize hospital safety based on many of the same individual measures as Medicare. Healthgrades, a Denver-based company, judges hospital quality with one, three or five stars. Consumer Reports calculates a safety score on a 100-point scale. Medicare hopes a star rating from the government will carry even more credibility. “People need this information now,” Scholnick said. “Trying to wait until everyone’s 100 percent happy with everything just delays it further than it needs to be.” 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.  

Decisio Health, a startup that aims to help acute-care provider organizations continually improve their clinical processes, launched the Decisio Health Clinical Intelligence Platform Tuesday and also announced $4.5M in Series A funding.

Proponents of virtual care say it is the wave of the future. But while the healthcare industry might not find much disagreement with the practice in theory, it is in the potential limitations that skeptics might find flaws.

The CERT Division of Carnegie Mellon's Software Engineering Institute has released its list of 10 technologies emerging in the next five years with the greatest vulnerabilities in terms of cybersecurity, finance, personal health and safety.

Valita Fredland most recently served as chief privacy officer and counsel at IU Health. In her new post, Fredland will serve as vice president, general counsel and privacy officer.

UC Health – the flagship University of Cincinnati Medical Center, as well as 167 of its affiliated practices – has reached the Stage 7 on the HIMSS Analytics EMR Adoption Model. HIMSS Analytics developed the EMRAM in 2005. Its eight stages (0-7) track a hospital’s implementation and use of health IT applications. In 2011, it launched the ambulatory model, meant to evaluate the progress and impact of EMRs for ambulatory facilities – physician practices, outpatient centers and specialty clinics – owned by hospitals in the HIMSS Analytics Database. Only 4.2 percent of more than 5,400 U.S. hospitals in HIMSS Analytics' database have attained Stage 7; just 7.9 percent of more than 34,000 ambulatory clinics have scored a Stage 7 Ambulatory Award. [Also: Benchmarks: Stage 7 success stories] UC Health, the University of Cincinnati’s affiliated health system is the region’s only academic health system.  It includes University of Cincinnati Medical Center, three additional hospitals, and the University of Cincinnati Physicians, Cincinnati’s largest multi-specialty practice group with more than 700 board-certified clinicians and surgeons. John H. Daniels, global vice president of HIMSS Analytics' healthcare advisory services group, said UC Health "has gone above and beyond the EMRAM Stage 7 criteria. They have already extended the closed-loop medication administration process to their infusion clinic and for interventional radiology cases. Combined with a strong population health program, the UC Health team is making a real difference in their community." "This accomplishment is due to our commitment to improved patient outcomes through the expanded use of information technology," said Jay Brown, UC Health's senior vice president and chief information officer, in a statement. "As the region’s only academic health system, we are surrounded by innovators and visionary leaders who have recognized the importance of leveraging these tools," he added. "The HIMSS Analytics Stage 7 Award highlights our dedication to delivering the highest quality of care and enhancing the experience of our patients."

Veterans are still waiting to see a doctor. Two years ago, vets were waiting a long time for care at Veterans Affairs clinics. At one facility in Phoenix, for example, veterans waited on average 115 days for an appointment. Adding insult to injury, some VA schedulers were told to falsify data to make it looks like the waits weren’t that bad. The whole scandal ended up forcing the resignation of the VA secretary at the time, Eric Shinseki. Congress and the VA came up with a fix: Veterans Choice, a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them. The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program — helping veterans get an appointment with a doctor and then working with the VA to pay that doctor. It sounds like a simple idea but it’s not working. Wait times have gotten worse. There are 70,000 more vets waiting at least a month for an appointment than there were at this time last year. The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don’t understand it, doctors don’t understand it and even VA administrators admit they can’t always figure it out. Veterans face delays and worry This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana Sen. Jon Tester sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy. “The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.” [See also: GAO: Veterans finding VA care hard to access.] Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients. “You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.” Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ” Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said. “You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.” He said he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly. “I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?” Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients. Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors. “The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.” The VA now admits the rushed timeframe led to decisions that resulted in a nightmare for some patients. Health Net declined to be interviewed for this story. But in a statement, the company said that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay. Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.” Scheduling lags also irk the doctors’ offices and the VA And there’s another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy. In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news. “I’m just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates,” she told a veteran. Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job. “I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said. Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this. She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.” It can take three to four months just to line up an office visit. The delays have become a frustration within the VA, too. Tymalyn James is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening. “The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.” The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care. At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year. Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself. “The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there.” Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution, a bill is expected to clear Congress by the end of the month. This story is part of a partnership that includes Montana Public Radio, WFAE, NPR’s Back at Base project and Kaiser Health News. The 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.

Early returns from the Health Care Innovation Awards, a CMS initiative that tests new payment and service delivery models, already "show a wide range of experiences that have resulted in tangible benefits for patients" and have helped the agency develop better policies, said CMS Chief Medical Officer Patrick Conway, MD.