Health IT

Implementing new health IT may decrease hospital mortality due to medication errors and uncoordinated care, but is the effect great enough to justify multimillion-dollar investments in new technology?  Maybe not, according to a new study from Health Affairs.

Spencer Jones and colleagues from the RAND Corporation looked at hospital outcomes data for Medicare patients from 2007 to see whether use of CPOE technology (Computerized Physician Order Entry) was associated with lower mortality for heart attack, heart failure, and pneumonia.  They looked at 4,644 general acute care hospitals, categorizing them by the percentage of orders written using CPOE.  There was a small reduction in mortality for heart attack and heart disease, but not pneumonia, associated with CPOE use – really small.

Based on the results, the authors predicted “complete uptake by hospitals of electronic medication ordering at levels comparable to the requirements of stage 1 meaningful use (at least 30 percent of orders written using CPOEs) could result in 1.2 percent fewer deaths of hospitalized Medicare beneficiaries from heart failure and heart attack,” but this result was not statistically significant.

In March, Fast Company magazine recently released their “10 Most Innovative Companies in Health Care” list for 2011. Somehow the article about it popped up on our Google Reader last week, so we decided to take a look. The list didn't seem to get much attention the first time around, and it's worth taking another look now. 

The list ranges from industrial titan GE, recognized for their vastly miniaturized handheld ultrasound machine, to the Cleveland Clinic, for “rethinking the entire hospital experience.” Nice to see companies on the list who are focusing on making medicine better, rather than simply making it more technologically advanced.

In 1997, the US Food and Drug Administration's neurological devices panel met to consider approval of a vagus nerve stimulator (VNS). The manufacturer, Cyberonics, said it could prevent or reduce seizures in patients with partial onset epilepsy who did not respond to drug treatment. The device consists of a generator the size of a matchbox that is implanted under the skin below the patient's clavicle.

A premature baby can be as small as the hand that cradles the head of a full-term infant. In a neonatal intensive-care unit, babies are often so covered with sensors that doctors and nurses struggle to find enough skin to place them on. A squadron of machines stands vigil around their tiny beds, monitoring heart rate and half a dozen other vital signs, in intervals that can be measured in thousandths of a second. All of this watchfulness is very expensive; a stay in a neonatal intensive-care ward can last months and cost hundreds of thousands of dollars.

With all the focus on health reform, we sometimes sort of forget that the Department of Health and Human Services is responsible for a whole lot of other aspects of health policy. Like about a zillion. Someone I know over there suggested I check out the HHSinnovates program on the department’s HHS.gov/Open website, and it was interesting to see how this big sprawling department with 300-plus programs is trying to create a “culture of innovation.” (I know, it can be a cliché, but take a look.)

Basically everybody in HHS no matter who they are or where they work can submit a bright idea. They aren’t supposed to be abstractions, but ideas that work and can be replicated and spread and expanded. Dozens of promising ideas get posted on a secure internal website, and then everyone at HHS votes. HHS Secretary Kathleen Sebelius recognizes the top ones.

This post was originally published in iHealthBeat, www.ihealthbeat.org.

HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, andwhile not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.

Second of the health tech-y posts for today. (We just did one on doctors rounding with iPads.)

Thomas Goetz, editor of Wired, published a book earlier this year called The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.  It came out several months ago, but we were pretty focused on health reform legislation at the time. Goetz, who has an MPH in addition to his tech/journalism career, is interested in consumer health, and the intersection between consumer health and technology, everything from simple self-monitoring iPhone apps to "proteomics" (a molecular medical technology which can potentially improve diagnostics of diseases like Parkinsons). Maria Gifford has an interview with Goetz up at getbetterhealth. We thought these two snippets drove home key points about what patients face in an overwhelmingly complex health system where the financial incentives permeating the system aren't necessarily pointing patients toward the best or most cost-effective (not a synonym for cheapest) solutions. Goetz wants to link information and action -- but keep in mind that the "right" action for one patient isn't necessarily the right one for all, and that "taking action" doesn't necessarily mean taking the most aggressive, expensive, newest action.

First of two somewhat health tech-y items today:

This post from a blog called FutureDocs by Vineet Arora MD describes the many ways an attending physician -- treating patients, supervising interns and residents and trying to keep up with email! -- used the iPad on and off service.

• Point of care teaching
• Preparing for teaching rounds
• Immediate access to a computer
• Access to patients medical record
• Balancing clinical work with academic work
• Relaxation! And keeping up with the nonmedical news of the day. And finding a good restaurant and a map (this was not at the bedside).

The ambulance crew gave the hospital staff at Corpus Christi Medical Center a fast rundown. Dennis Fegan, 48, had passed out at his home about 30 minutes earlier. Luckily, his parents were visiting, and they called for an ambulance after he fell from a dining chair to the floor. Then Fegan woke up, just as suddenly as he had collapsed. Three minutes later, he passed out again for less than a minute; then he came to. By the time the medics arrived, Fegan's parents had watched their son lose and regain consciousness at least eight times.