Bad EMRs?

posted by dls at 6:42 am

Symcat blog has a recent article on “Bad EMRs.” It’s brief but worth a read. The authors really know what they’re talking about. They point out the financial, operational and clinical promises that are, in light of structural problems, unlikely to meet market needs.

My colleagues and I wrote a white paper sponsored by Microsoft–of all people–years back that covers in more depth the issues that EMRs/EHRs face. The long and short of it is that the approach to building such things is unlikely to succeed in light of what is known about the history of innovation.

Electronic records hold great promise, but their path to genuine usefulness is mostly unknowable. What’s more, current trajectories are less likely to deliver what healthcare needs than more “disruptive”–to use a friend’s terminology–approaches.



The 5 percent Solution

posted by dls at 5:57 am

Currently, there is a secondary market in surplus supplies in hospitals &c. New businesses are buying up unused–sometimes expired–supplies from large HCOs and reselling them to smaller HCOs for a tidy profit. As a colleague and I are trying to calculate the size of this market, we see more and more businesses cropping up. The size of this market that exists based solely on the waste-stream from large HCOs is growing rapidly.

Supply costs this year are estimated to be $400B. Five to ten percent savings means big money. My colleague and I are advocating a customer service focus approach to saving this money, which will lead to continued savings for at least a few years to come.

In brief, if hospitals got straight on and took seriously their own internal customer-supplier relationships, they would avoid underwriting other businesses through their wasteful practices, while at the same time improving all of their operations. (And improving operations surely will result in higher quality at lower cost.)

HCOs can, when they put their minds to it, achieve amazing things. Savings of $20B to $40B is there for the taking.



Sundahl to Speak at 2013 VHA COO/CFO Forum

posted by dls at 12:38 pm

Shameless self-promotion: I’ll be presenting (and on a panel) at the upcoming 2013 VHA West Coast CFO/COO Leaders’ Forum.

The title of my talk is “Frontline Sustainability: A Human-Centered Approach to Transformation.”



Failure: How to Boost Success and Creativity

posted by dls at 10:17 am

Many of us know (1) that failures are inevitable and (2) that failure can create learning opportunities. But there is more to it. On the 99u blog Heidi Grant Halvorson points out that fear of failure–or the inability to embrace it–hinders our short-term abilities to achieve important tasks.

Halvorson writes about what she calls the “Be-Good” mindset vs. the “Be-Better” mindset. Perhaps the most interesting thing Halvorson points out is that the “Be-Good” mindset actually decreases our performance on cognitive and creative tasks.

I think most of us (at least I do) think that we really do embrace the “Be-Better” mindset. But, let’s face it, that’s just how I wish I was. In reality, I worry about screwing up–I get embarrassed and defensive, and simultaneously diminish the parts of my brain required to get better and to succeed in the present.

In our firm, we try to convince clients (and model the behavior) that system failures can either frustrate us, or engage us in a creative exercise of improvement. Halvorson adds a dimension to this I’d never seen. And what’s more, Halvorson gives some good, practical advice on how people like me can come to be better by embracing the inevitable.



Bed Alarms May not Prevent Falls

posted by dls at 9:36 am

Here I just wanted to make sure that people saw a link by “Kevin MD,” a prolific blogger and tweeter.

Article here.



Interruptions (in care) More Significant than Thought

posted by dls at 9:06 am

In this article, Erik Altmann of Michigan State describes his research showing that a mere 3-second interruption doubles error rates.

I’ve never seen a doc or nurse go for more than a minute with at least two 3-second interruptions.

Altmann focused on computer tasks, which, frankly, ought to concern all of us as EHRs–including CPOE–are becoming more common.

I think that as important as EHR deployment and compliance with meaningful use requirements are, we must spend time, effort, and even money on eliminating the “noise” that hurts (or at least potentially) hurts our patients.



Leadership and Patient-Centered Care

posted by dls at 6:04 am

The November/December edition of the Journal of Healthcare Management has a brief piece on the role of leadership in patient-centered care.

The article reminded me of an experience we had with a client. At the time the client was losing a great deal of money on their skilled-nursing unit. There had been an ongoing argument about whether to close it. On one side of the debate, people argued that the hospital should not abandon patients that needed something from them. They argued that the answer to the problem was to figure out how to run it more efficiently, so that they could maintain the service. On the other side of the debate, they argued that closing it was the most responsible thing to do: no margin, no mission. The skilled unit was diverting resources away from other important priorities in the hospital.

In a way, you can argue that both sides of the leadership’s disagreement (this included the board) were concerned about patients.

But as we facilitated this decision-making process, we uncovered that this was only half true. Both had a concern about patients, but neither group had actually put real patients and their needs at the center of the debate.

My job, as it always is, was to keep them not just focused on being patient-centered, but forcing them to figure out how to operationalize this wonderful idea–since that’s all it was at this point. In our work, we ensure that decisions start with the moral dimensions of healthcare: how do we do the right thing for each of our patients. In a way that we can afford, of course.

We helped the group investigate the financial issue through the lenses of meeting each individual patient’s needs exactly. In reviewing previous charts and looking at their current patients, with an eye to exactly what each patient needed, they found 28 of 29 patients really needed something other than their skilled unit. And the 29th was from two hours away–in between the hospital and her home were several SNFs (skilled nursing facilities) that would make life a lot easier on her family.

Once patients on the unit were placed where they truly belonged, the unit was empty. Operationalizing the slogan “patient-centered care” eliminated the dispute. No longer were they just arguing their side and tacking on, “for the sake of patient-centered care.” Patient-centered care had guided their entire decision-making process.

There are many other terrific details of this story, but–cutting to the chase–redeploying staff and closing the unit were, according to the CEO “kind of anticlimactic.” “No drama,” the CFO said. “Just the way I like it.”



IHI Faculty named MacArthur Fellow – words to the wise

posted by admin at 3:24 pm

Dr. Eric Coleman, professor at the University of Colorado School of Medicine, has wise words for us all. In his MacArthur Fellow video, he notes that “… patients and families learn best when they get to try things out”. His innovative Care Transitions Program essentially coaches patients and families for their next health care encounters by using simulations, practice and rehearsal. We might say “testing” their way to understanding.
At the Institute for Healthcare Improvement, Dr. Coleman has been integral to the reducing readmissions work. View his short video at: http://www.macfound.org/fellows/863/



Medicare Usage–Up or Down?

posted by dls at 8:40 am

A post from Healthcare Economist points out something very interesting: people who had insurance before they started receiving Medicare benefits do not change their healthcare consumption patterns very much. That is, though they’re aging, they don’t cost much more to care for.

On the other hand, people who were not insured before getting onto Medicare turn out to utilize Medicare at a much higher rate.

I don’t know what this means for Obamacare–probably nothing. But still interesting.



The Future (and Past) of Healthcare Costs

posted by dls at 8:09 am

The most recent issue of Health Affairs is focused on payment reforms in healthcare. The opening editorial runs quickly over the things that have/are working and those that aren’t.

I noticed that Stuart Altman has a piece in this issue. I recently had a conversation with him that was brief, but I felt revealing.

Me: Since demand for healthcare is essentially inelastic, aren’t we just stuck playing a constant game of whack-a-mole? [Put another way: aren't we just going to have to keep chasing costs all over the industry and trying to lower them?]

Stuart: Yes. I just think we should get better at whack-a-mole.

So, here’s to Health Affairs trying to make our whack-a-mole efforts more effective.