Connected Thinking Blog - NACHRI Conferences

Keep Those Patients Moving - streamlining flow and eliminating waste

In a shared presentation, staff from Children’s Specialized Hospital, Mountainside, NJ, and Banner Children’s Hospital at Banner Desert Medical Center, Mesa, AZ, shared their experiences in streamlining patient flow and staff flow to see radical cost savings and patient satisfaction improvement. 

Michael Marranca from Children's Specialized Hospital closed their presentation with a quote from Shigeo Shingo of Toyota: "The most dangerous kind of waste is the waste we do not recognize." This idea was epitomized in the presentations, where careful, critical analyses of clinical flow showed numerous, unexpected areas for improvement.

The slides and session overview on the NACHRI site paint a detailed picture of challenges, findings and results, which saved hundreds of thousands of dollars, reduced wasted clinical time more than 50 percent, and made great leaps in Press Ganey patient satisfaction scores.

Check out the Children's Specialized Hospital presentation, Our Patients Shared, We Cared & Dared to Be Lean.

Check out the Banner Children's Hospital presentation, Keep Those Patients Moving!

VHS vs BetaMax: What Healthcare IT Can Learn

It happens all the time.  Someone comes out with a great idea/product, then someone has a slightly different version and so on and finally, the consumer is left to wonder which is better and choose.  And, in a perfectly free market world, price and quality would win out.  A quick look at technology's history, though, shows that big business, special interest and pure politics don't always allow the "best" to win out.  Before DVDs and TiVo, there was video cassetes.  And the two early leading formats were VHS and Betamax.  Arguably better, Betamax lost out to VHS due in part to great marketing on the part of VHS proponents. 

EMR standards could go the same way - the best standard not being the one adopted.  For electronic medical records standards, healthcare IT should not repeat the VHS/Betamax story. 

Healthcare information technology needs standardization.  While we all want the utopia of interoperability - a patient's "chart" can be viewed by any provider regardless of the information system they are using (or not using) - getting there is a daunting challenge.   Groups like the Certification Commission for Healthcare IT can help avoid a repeat of the VHS/Betamax story.

The mission of the Certification Commission for Healthcare Information Technology (CCHIT) is to accelerate the adoption of robust, interoperable health IT by creating an efficient, credible certification process.  As a non-profit entity, this commission takes input from pediatric communities, other pediatric health IT standards setting organizations and uses these input to create the functional and interoperability criteria to improve health care. 

Free market forces are always needed, but in healthcare IT, standards should not be based on "popularity" but rather start with the clinical needs of a patient's record.  With a number of electronic medical record vendors in place, spiraling of vendor specific standards already are occuring and the need for interoperability is already behind the 8 ball.    After all, we are not talking about how to watch a movie...we are talking about something slighly more important...patient care.

What do you think?  Is this a big deal?  Are there parallels between VHS/Betamax and what is happening with EMR standards?  Does this even matter as it will all eventually work itself out?

Enhancing Patient Safety Through the Implementation of Technology

In a panel presentation with representatives from Nemours Children's Clinics in Florida, Alfred I. duPont Hospital for Children in Deleware and Children's National Medical Center in Washington, DC, presenters shared how the implementation of pediatric health information technology has affected their ability to provide safe, effective care.

At Nemours Children's Clinics in Orlando, Pensacola and Jacksonville, a technology-driven push has been made to eliminate unsafe abbreviations, as defined by one of The Joint Commission's National Patient Safety Goals in 2004. A poignant story was shared about a young nurse who mistook a physician's poor handwriting for an order for magnesium sulfate (MgSO4) as an order for morphine sulfate (MS04) and administered the wrong drug to a patient with head-injury. The patient suffered no ill effects -- in fact, the patient requested more morphine because they liked it -- the nurse on the other hand went home traumatized. She never came back to the hospital. The presenter saw her a few months later, at the mall, selling cell phones. She was unable to overcome the thought that her potential error might harm someone. The story drove home the point that with unsafe abbreviations, there can be harm done on both sides of the syringe -- all the more reason to completely eliminate unsafe abbreviations.

Nemours implemented monitoring and correcting software on all of its computerized physician order entry (CPOE), and observed a 3 percent baseline use of unsafe abbreviations in the SIG field of its electronic medical records in April of 2007. Less than a year later, thanks to software that corrects or rejects any potential unsafe abbreviations from being keyed, they are down to 0.002 percent unsafe abbreviations -- almost total elimination of any unsafe abbreviations in their electronic system.

Administration attributes some of the rapid success of the program to the competition between different clinics, who were all striving to improve faster than one another -- a healthy competition and full disclosure of usage rates for unsafe abbreviations helped encourage all clinics to improve as quickly as possible.

Do you see competition in your hospital -- among system hospitals, clinics or even different departments -- as a catalyst to improving processes? In what ways do you see technology changing care -- for the better or worse -- in your hospital?

Listen to the audio recording. (MP3, 94 MB)

Lost II - still not the series

What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do.

John Ruskin

Oh yeah, it would be good to tie things with the conference....creating connections and all.  And that is what the writers of Lost are doing - connecting the dots and making the story visible one episode at a time.

See, in Lost (the series) the Island is a character...it has its own mysteries and secrets.  It seems to possess great power and has supernatural forces that keeps the survivors guessing.  And then there are the "others" - people! already on the island.  The survivors are shocked to find them in their midst...

So too in healthcare, there seem to be mysterious powers and supernatural forces (the insurance companies?) and the "others" .  Who might the "others" be?  The federal government?  HMOs? Drug companies?  Take your pick..the others are always the easiest to find...the proverbial "they" as in, "they make it harder to see my patient"..."they lost your prescription"..."they canceled your benefits"..."they lost the paperwork on your referral"...you get the idea. 

The others are always going be there.  Health information technology won't get rid of the others but it can lessen their effects:   Data and information available anywhere, anytime.  Clinicians able to quantify data to enhance patient care.  Disparate organizations able to share information that is standardized and do so freely.  That would an evolutionary step in the right direction.

Lost - not the series

When you are through changing, you are through.

Bruce Barton

I recently discovered the ABC TV series Lost.  Yes, it has been on for about 3 years (so I am a little behind) but I find it fascinating...a group of passengers crash land on a remote island, a doctor (Jack Sheppard) is one of them...the physician tries to take charge (and does) but it is difficult to care for patients with little resources, little medicine, crude supplies and no power; and doubly difficult to go it alone.  He eventually realizes he needs the survivors to work together.  And even though they all want the same thing - to get off the island - it is extremely difficult to make things work.  To top it all off,  they all have secrets in their lives that somehow connect to each other.  And story unfolds slowly, with twists and turns, new revelations, discoveries and inexorably each episode leaves more questions as it answers old ones...sounds familiar...

Hmmmm...in many ways, not unlike healthcare today.  Patient care isolated and working in silos, in islands of care.  Not connected with friction between the people seeminly having the same goal in mind.   Limited resources.  Massive amounts of data and information that needs to be shared by sometimes scores of individuals simultaneously.  How do we get off this island?  How do we get rescued?  Is there a single answer?  Much like the TV series, the answer is complex, sometimes magical, always elusive and still being written...but health information technology must be part of the answer...because use of health information technology is not revolutionary...it is evolutionary