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Monday Morning Update 5/19/14

May 17, 2014 News 15 Comments

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Robert Petzel, the VA’s undersecretary of health, resigns over allegations of falsified electronic wait time records at  the Phoenix VA hospital. The only benefit is political since Petzel had previously announced plans to retire this year. Arguably the VA and Kaiser have led the healthcare industry in innovation, quality management, and use of technology even though the VA is, like all federal agencies, a politically motivated money pit. The VA’s problem is the tsunami of returning veterans who were sent off in huge numbers to fight pointless political wars that left many of them physically and psychologically damaged, leaving the VA to pick up the healthcare pieces with minimal increases in funding. It would be interesting to see the VA’s volume and quality metrics over the past 10 years. The VA is the ultimate ACO provider that might be able to provide warnings about the hazards ahead to the ready-fire-aim pioneers charging down the path of managing populations even though their outcomes and cost effectiveness in managing individual encounters have been unimpressive.


Reader Comments

From Beth: “Re: IT productivity. I’m looking for better ways to measure and compare with other facilities. Do people use closed help desk tickets, number of network nodes, number of user accounts, adjusted patient days, or some other formula?” Leave a comment if you can help Beth. It’s always tough to benchmark IT as an entire department since hospitals configure it differently – outsource parts of it, include biomedical engineering or not, have field support in individual hospitals in the system that aren’t assigned to corporate IT, use external consultants for application support or training, etc. I’m always skeptical of benchmarking since it’s hard to find a two hospital IT shops that are mostly alike, not to mention that once metrics have been identified, everybody’s goal shifts to gaming them rather than actually improving service (see: VA patient scheduling.) It’s like school testing: the metrics are supposed to be a by-product of excellence, not the sole focus of the program where teachers teach run entire classes on how to pass standardized tests rather than comprehend reading and math. Maybe that’s a case for metric opacity vs. transparency – let an independent organization define and report the metrics as broad themes without telling anyone, including management, how they are measured. That keeps your help desk people from begging users on Friday to let them closed unresolved tickets so that Monday’s numbers don’t get them in trouble.

From The PACS Designer: “Re: Apple and biosensing. They have a patent for a pedometer that could be a biosensing device as well for an iWatch. Apple has hired biomedical engineers from Vital Connect, Masimo Corp., Sano Intelligence, and O2 MedTech.” The timing is good since the fitness tracking device craze is in full retreat, making it ripe to become just another part of your smartphone rather than a dedicated piece of hardware, much like portable music players. Few people want to pay $100 for a not terribly intelligent pedometer that needs to be recharged separately.


HIStalk Announcements and Requests

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The recent buzz about athenahealth’s prospects and share price was negative to one-third of respondents. New poll to your right: should ONC require certified EHRs to offer open APIs? You can elaborate further after voting by adding comments to the poll.

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Welcome to new HIStalk Platinum Sponsor Glytec. The Greenville, SC-based company is admirably focused on one big hospital problem: improving insulin management and glycemic control. Around 40 percent of inpatients experience hyperglycemia or hypoglycemia during their stay, which requires lot of clinician time and contributes to infection, length of stay, and mortality. Glytec’s Glucommander Suite is the only FDA-cleared glycemic management and surveillance system. It delivers physician-directed computer algorithms to both adult and pediatric patients and those on either IV or SC insulin. It offers one-click access to the patient’s chart in the EMR. GlucoSurveillance flags patients in real time who may require glycemic therapy, while GlucoMetrics Analytics monitors the success inpatient glycemic control initiatives. According to the VP of medical affairs of Sentara Healthcare, “If you aren’t using Glytec, you aren’t using the standard of care,” while University of Virginia’s consult team reported a length of stay reduction of over one full day in the first six months of using Glucommander. Thanks to Glytec for supporting HIStalk.

I found this just-published YouTube video by Sentara Healthcare describing  in a remarkably frank manner the problems it was having with glycemic control and how it uses Glytec’s eGlycemic Management system. It isn’t the usually glossy overview – the physicians in the video get into specific details, such as how they made EMR changes to drive some improvements but then “hit a wall.”

Listening: new Tori Amos.


Announcements and Implementations

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Health Datapalooza announces the speaker lineup for its June 1-3 conference in Washington, DC: US CTO Todd Park, HHS Secretary Kathleen Sebelius, AHIP CEO Karen Ignagni, author and surgeon Atul Gawande, athenahealth CEO Jonathan Bush, UK Secretary of State for Health Jeremy Hunt, and Time author Steven Brill, among others. I’ll be there, so you’ll read more about it on HIStalk. I don’t attend many conferences and in fact I don’t even hear about most of them (the appetite for HIT-related conferences is apparently ferocious given the number of people who seem to make a career of tweeting from them), so if there’s one you recommend that’s worth the time and money to attend, let me know.

Massachusetts Health Data Consortium elects four new board members: Frank Barresi (VP/CIO, Fallon Health); Julie Berry (CIO, Steward Health Care System); Joseph Frassica, MD (VP and chief informatics / chief technology officer, Philips Healthcare); and James Noga (VP/CIO, Partners HealthCare.)

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IBM announces that Modernizing Medicine is one of three partner companies that will release “Made with Watson” apps this year. The company offers specialty EMRs and is developing an iPad app that will guide physicians through a patient encounter to provide evidence-based medicine suggestions.


Other

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Constantine Davides of AlphaOne Capital Partners LLC has updated his HIT Family Tree that shows pretty much every company’s acquisition history over the years. It is fascinating, useful, and sometimes a bit scary when you see the number of acquired pieces and parts that make up a vendor’s “integrated” systems.

Apple and Google drop their smartphone lawsuits against each other and agree to work together on patent reform.

The Chicago business paper describes interesting hospital-doctor conflicts at 313-bed Swedish Covenant Hospital (IL) following the hospital’s firing of its chief of medicine after he and other of his independent practitioner colleagues joined a rival hospital’s accountable care organization. The issues: (a) new payment models make it difficult for doctors who practice at multiple hospitals to choose their loyalties; (b) independent doctors say they are forced to take ED call, but most of the patients they see there are sent to the hospital’s employed physicians; (c) the hospital is demanding that independent practices adopt EHRs that integrate with their systems, leading to concerns that the hospital will use the information in them to tell them how to practice medicine (which of course they will since that’s the whole point of analytics-powered population health management, which like most powerful forces can be used for both good and evil.)

The former president of the Philippines, now a representative, proposes creating an Electronic Medical Record Center (an HIE-like central records strorage center) under the Department of Health, with initial funding of $230,000 USD.

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Long Island Jewish Medical Center (NY) installs video cameras in all of its 24 operating rooms as a remote video auditing (RVA) system. Staff will check the cameras every two minutes to make sure the surgical teams take the mandatory pre-procedure timeouts and patient safety measures. The cameras will also be used to alert housekeeping of completed procedures so they can clean the room and as a video record that room disinfection was performed properly. The video can be monitored live throughout the OR and on smartphones. The system was provided by the hospital’s anesthesia contractor and Arrowsight, Inc., whose video system the hospital installed in 2011 to improve hand hygiene rates to nearly 90 percent (I’m picturing in-room loudspeakers from which emanate the stern voices of invisible handwashing video overlords who tell doctors to step away from the door and toward the sink.)

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Centura Health (CO) will replace Meditech with Epic, a good source tells me.

Police say they may make more arrests in the identify theft case at Albany Medical Center (NY), in which a nurse and her boyfriend have been arrested for using the Social Security numbers of over 100 patients to apply for credit cards, write bad checks, and file fraudulent tax returns.

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New tax returns filed by UPMC disclose that CEO Jeffrey Romoff was paid $6.6 million in 2012, with 30 other health system executives and physicians exceeding $1 million each in compensation. SVP/CIO Dan Drawbaugh makes the list with $1.6 million in 2012 income, a big drop from the $2.3 million he took home the previous year. UPMC is famously embroiled in a lawsuit with the City of Pittsburgh in claiming that it is a humble non-profit that should not contribute to the city’s budget by paying taxes.

Here is Regina Holliday’s keynote speech from the We Can Do Better conference from a couple of weeks ago.


Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect

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Currently there are "15 comments" on this Article:

  1. Thanks to all who have served our country. If you have lost a friend or loved one, please know that it was for our security and in protection of our freedoms; not for “pointless political wars” as it has become fashionable for the highbrow self proclaimed elitists to now say. The majority of Americans are grateful to all our men and women who are serving and who have served our country. Their service and sacrifice is honorable and not “pointless”.

  2. ” It would be interesting to see the VA’s volume and quality metrics over the past 10 years. The VA is the ultimate ACO provider that might be able to provide warnings about the hazards ahead to the ready-fire-aim pioneers charging down the path of managing populations even though their outcomes and cost effectiveness in managing individual encounters have been unimpressive”

    That is one of the insightful statements you have made. Has anyone thought that the VISTA EHR system creates workflow inefficiencies keeping the doctors from expanding their volume of cases seen?

  3. Thanks to all the brave men and women who served our country, many of them with multiple tours of duty. Politics is involved in almost every war including WW1, Korea and Vietnam.

    I believe the VA was swamped with volumes of patients with ailments they were ill prepared to treat. They may not have had the resources to provide the doctors and specialists to treat our returning heroes but if that were really true, what great publicity that would have made! It would have made the congressional reaction to Hurricane Sandy seem small. But like a true government agency, it chose to cover it up with made up numbers. The usual will happen – someone resigns but gets no punishment – their pension is still there and bonuses continue. Why should senior level bureaucrats care how they perform if there are no repercussions?

    So what will happen now that we have increased the number of patient through extensions of Medicaid and the ACA that our health system is ill prepared to handle? Remember we are cutting reimbursement to pay for these programs.

  4. Please avoid applying political points of view on issues, which are mostly unrelated to treating our veterans and delivering healthcare. Reasonable people can disagree.

  5. Numbers for the VA are available at benefits.va.gov and there are still nearly ~600k claims still pending for benefits. So much for the ’12 campaign mantra about making it a priority among both parties whether an executive priority or larger funding through Congress to speed up processing.

    So tired of the ‘support the troops’ empty mantra which started in earnest during the first Gulf War that is still repeated by politicians and most Americans.

  6. Please continue to pepper your articles with political points of view, or in the VA article, fact. It provides good and enjoyable reading. You do not buckle when vendors can not handle the truth, please do not listen to people that can not handle the truth.

  7. re:Health Datapalooza. Those are many of the same speakers as last year (Park, Hunt, Sebelius, maybe even Gawande?). It’s definitely a fun conference with great networking, but the content may be plateauing.

  8. “Pointless political war…” Just be careful this HIT site doesn’t become politically biased and pointless itself.
    Attempting to subtlety interject political points of views turns readers off.

    Besides, if you ask our service men and women if it was pointless I think they would disagree.

    Shame on you.

  9. Why don’t we give Veterans Medicare benefits with a supplement that will pick up the balance left over and put them in the system with all other patients? Why do they need to sit waiting on a VA hospital to see them when they could go to anyone who takes Medicare and be seen more timely and have more control over their own health?

  10. Meanwhile, Sharon Helman, the director of the Phoenix VA Medical Center at the center of this whole mess has not been asked to resign, and instead is sitting at home on administrative leave collecting her $100k plus salary and benefits. This despite former colleagues now coming out of the woodwork to report that her corrupt leadership practices had gone on for years at the VA facilities she’d worked at in her past. The VA was just desperate to find someone to march to the gallows before it came across like they did not care what happened, and Robert Petzel fit the bill nicely because he was retiring anyway. He’ll still get his retirement pay, an expensive hail and farewell party, and a feel-good plaque to hang on his office at home. This move was nothing more than the VA trying to quiet the growing demand for Secretary Shinseki himself resign from his position.

  11. I’m tired of seeing people falsely equate disapproval of a war with disrespect and ingratitude for the men and women who served in it. One obvious way to show our gratitude for our armed forces’ service is to not send them needlessly into harm’s way.

    As for those asking for politics to be kept out of Mr. HISTALK’s commentary, I would remind them that this is a blog, not a professional media outlet aspiring to absolute objectivity. I think if politics are pertinent to a topic, it’s fitting for Mr. HISTALK to offer his opinions on the matter, as he does with all the other topics that appear here.

  12. @RB: “One obvious way to show our gratitude for our armed forces’ service is to not send them needlessly into harm’s way.”

    Another powerful way to show gratitude for veterans is to hire them. Thank you Mr. H for doing just that and giving me the chance to be part of the HIStalk team. I’ve loved it since my first day.

  13. “… installs video cameras in all of its 24 operating rooms as a remove video auditing (RVA) system” I think it’s supposed to be *remote* video auditing.

    [From Mr H] Thanks – fixed.

  14. Kudos to Glytec Systems for breaking into this much needed area. My oldest daughter was a type 1 diabetic. She was diagnosed when she was 12. She was in and out of ICU every few months because even an ingrown toenail would lead her quickly to ketoacidosis. It happened in the city where we lived, it happened in the cities where she was vacationing or visiting family. As a parent it was frustrating to see the hospital staff try to manage her blood sugar and fail. There were times when, once they got her out of the danger zone I signed an AMA form and managed her insulin myself. During one incident they stabilized her at one hospital and then decided to have her transported to the pediatric ICU at another hospital only a few miles away. Lack of communication and break downs in process led the discharging hospital to remove her IV insulin an hour before the ambulance picked her up. Apparently you can’t have insulin in an ambulance without an RN. I didn’t understand at that time that IV insulin stops working shortly after the administration stops unlike the in bolus method we used at home. I won’t go into all of the details but by the time she was admitted at the other hospital she was in crisis again. This time her brain swelled and she went into a coma. There were four physicians on her case, one an endocrinologist and they couldn’t figure out what the problem was. They even sent for new insulin thinking maybe what they were administering had a problem. We had “the talk” and they told us there wasn’t anything else they could do and it was up to her body at that point. After 14 hours she came out of it. It was maddening to me that my daughter’s life was on the line because of a lack of communication and a breakdown in the process.

    As someone who has worked in Healthcare IT for about 20 years witnessing the obvious gaps in systems and the inconsistency of care, I am very excited about what they are doing. I can’t wait to learn more and hear about the future successes and positive patient outcomes Glytec Systems will enable.







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