ONC Chief tapped to help

ONC Announces Health IT Challenge 

The ONC launched this week its latest prize challenge to spur innovation and promote real-world use of health information technology.  According to a blog post, nearly $700 million was invested in health technology in the first quarter of 2014 - an 87 percent year-over-year growth. The ONC is looking to support start-ups that are having difficulty connecting with pilot partners to test innovations such as web and mobile applications. To that end, the Market R&D Challenge calls on health innovators to partner with providers, clinics, or hospitals to develop a pilot proposal and run the pilot for 6 months.  The program will select up to six teams to implement the pilot, conduct a rigorous evaluation, and disseminate its findings in collaboration with ONC.   

ONC will award $25,000 when the teams are selected, and another $25,000 following completion of the pilot and evaluation.  The ONC will be holding matchmaking events In January 2015.  Proposals for the challenge are due March 2, 2015 and teams will be selected in April.  For more information, visit www.oncpilotchallenge.com.

Other news about the Office of The National Coordinator for HIT.

DeSalvo Out as ONC Head, Moved to Ebola Fight.

Karen DeSalvo, MD, the national coordinator for health information technology for HHS, is leaving her post to to address public health issues, including becoming a part of the Department’s team responding to Ebola. She took over as the ONC head in January, 2014.

The ONC’s COO Lisa Lewis will serve as the agency’s acting national coordinator.

HHS spokesman Peter Ashkenaz told THCB:

“HHS Secretary Burwell asked National Coordinator for Health IT Karen DeSalvo to serve as Acting Assistant Secretary for Health, effective immediately. In this role she will work with the Secretary on pressing public health issues, including becoming a part of the Department’s team responding to Ebola. Dr. DeSalvo has deep roots and a belief in public health and its critical value in assuring the health of everyone, not only in crisis, but every day.

Lisa Lewis, ONC’s chief operating officer, will serve as the Acting National Coordinator. However, Dr. DeSalvo will continue to support the work of ONC while she is at OASH.”

The transition comes at a time when critics are asking tough questions about the government’s Meaningful Use program and providers’ lackluster progress qualifying for Stage 2.

Moving Karen Desalvo to the Ebola crisis places her expertise with the team working on Ebola containment.  A smart move.

Karen DeSalvo, who was appointed acting assistant health secretary Thursday, will continue to hold her current role as director of the Office of National Coordinator for Health Information Technology as she serves in her new role for the Department of Health and Human Services.

ONC released an update on DeSalvo’s new responsibilities Thursday and said she will continue to work on “high level” policy issues for the office and remain as chair of the Health IT Policy Committee.

She will also lead work on the development and finalization of ONC’s Interoperability Roadmap and co-chair HHS’ cross-departmental work on delivery system reform, ONC said.

Lisa Lewis, chief operating officer and acting director of ONC, will oversee the day-to-day operations of the office and served as acting principal deputy national coordinator before DeSalvo joined ONC.

DeSalvo joined HHS to help with the department’s response to the Ebola outbreak in West Africa.

- See more at: http://www.executivegov.com/2014/10/onc-karen-desalvo-to-retain-natl-health-it-coordinator-role/#sthash.aPUOnCgj.dpuf

When Is An Impatient Physician Disruptive ?

 Sometimes disruptive behavior can be a good thing.  Not all disruption is due to  technological changes, such as electronic health records.  And some technical disruptions often spur other developments and growth in other industries, perhaps even creating a whole new niche.

Has the healthcare industry gone too far in cracking down on disruptive behavior? Is it okay for doctors to be rude, dismissive and act like jerks if they have superior surgical skills?

Hospitals have long struggled with how to handle disruptive behavior among doctors, sometimes turning a blind eye, other times disciplining or firing them. Getting rid of disruptive docs has become a popular approach as the industry rewards organizations for high patient satisfaction scores.

The biggest problem with disruptive workplace behavior is the negative impact it can have on the patient, FierceHealthcare reported earlier this year. In many instances, the bad behavior distracts the healthcare team, which can lead to medical mistakes.

But aarticle by Becker's Hospital Review calls into question the "zero tolerance" movement and why disruptive docs may not be so bad after all. While some surgeons may be cold and abrasive, they may also be better doctors than their kinder, gentler counterparts, according to the article. Yet the doctors with the better bedside manners are rewarded because they have higher patient satisfaction scores even though they have poor patient outcomes compared to their meaner counterparts.

"In trying to shape our trainees to be all things to everyone ... we run the risk of creating a workforce caught somewhere in the middle, not doing anything well," Shen says.

So how does the industry balance the need for happy patients and skilled clinicians? One way is to recognize that satisfaction--how positive a patient feels about an encounter--is just one part of the patient experience, writes Jason A. Wolf, president of The Beryl Institute, in a blog post for Hospital Impact.

There are divergent opinions as to what effect disruptive behavior can have..

The Joint Commission clearly states,  "disruptive behavior is a sentinel event"

Behaviors that undermine a culture of safety---NOT

The preceeding quotes are attributable to FIERCEHEALTH

Another point of view, from The Health Care Blog

lawyerdoctor says:

Kudos to Dr. Gunderman for his thoughtful, and analytical evaluation of our current “quality morass.”

We used to have people who were responsible for providing “quality health care.” They were called DOCTORS. If someone didn’t do the right thing, they may or may not have received a butt-chewing. The most powerful incentive for the hospital to provide quality care to the patient was likely the surgeon, whom everyone respected and likely feared a little bit.

One of the most powerful experiences of my medical education was being fortunate enough to spend some time under the tutelage of a small-town general surgeon. He was the most scholarly, genteel, polite, and skilled physician (or person) I think I have ever met. He was so revered and respected in the community that one day he almost made the Director of Nursing break into tears from one simple courteous statement. It was during an operation wherein the staff had forgotten to supply an important surgical tool, and we stood there in sterile scrub, hands folded across chests, for what was about 10 mins (but seemed an hour).

The surgeon said kindly: “Nurse X, you understand that WAITING – is the thing that I do LEAST well.”

I thought the entire nursing staff was going to faint. The item was produced forthwith.

Grass Roots HIT in the Hospital and Clinic

Clinicians are an innovative group. From physicians, nurses, pharmacists, administrative personell, all are users of mobile apps at home and/or work.

mHealth News reports that there are some "apps that clinicians can't quit". Patients at the Hospital of the University of Pennsylvania (HUP) might wonder why their nurses are always on their smartphones — until they learn those nurses are actually sending secure messages to everyone on a patient’s care team.

It’s part of a highly successful pilot that began more than a year ago, and one that caregivers don’t ever want to see end.

What made this pilot unique is that it was grassroots-driven,” said Neha Patel, MD, one of the pilot’s developers.

Patel, an assistant professor of medicine at HUP, partnered with the information systems department at Penn Medicine to develop an mHealth strategy that would not only improve communication among a patient’s care team, but also save clinicians time.

Patel and a colleague will discuss the pilot at the upcoming mHealth Summit in December outside Washington, D.C.

For the pilot, which began in May 2013, residents, faculty physicians, pharmacists, social workers and discharge planning nurses were provided with iPhones or iTouches in four of the hospital’s departments: three general units and one surgery outfit. They used a secured-messaging mobile application called Cureatr to communicate everything but emergency messages with a patient’s entire team. As shifts changed, the phone was passed on. Communication remained fairly seamless, Patel said.

Now, nearly a year and a half after the pilot started, staff at HUP refuse to let go of their phones or Cureatr. When house staff rotate to units that don’t use the app, Patel explained, they complain that communication is “archaic.” 

It’s no wonder. A HUP time-motion study showed residents were spending about 20 percent of their day communicating with other healthcare providers, either face-to-face or on the phone

Another home-grown application, Connexus.(Connexus®, the Education Management ,  an app that allows providers to pull up patient data on their smartphones.

System(EMS). Connexus has been adopted by various user groups for purposes beyond the original design scope:. “Anesthesiologists, for example, are using it for pre-op evaluation, ancillary providers to follow the ‘thinking’ of the primary team, and consultants to quickly evaluate a new patient.".

The lesson is that iit does not take a million dollar investment to design HIT solutions for the hospital, or clinic. Individual initiative and grass roots trials are often more creative and functional than a poorly designed commercial medical app

AMA Calls for Design Overhaul of Electronic Health Records to Improve Usability

Much controversy has arisen regarding the usability and loss of efficiency when electronic health records were introduced and then incentivized as a mandatory component of physician practice. Electronic records have been in existence for 15 to 20 years, however most are woefully inadequate when it comes to usability.

ref: HITECH Answers

While AMA/RAND findings show physicians generally expressed no desire to return to paper record keeping, physicians are justly concerned that cumbersome EHR technology requires too much time-consuming data entry, leaving less time for patients. Numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology, “most office-based providers find themselves at lower productivity levels than before the implementation of their EHR” and that “workflow, usability, productivity, and vendor quality issues continue to drive dissatisfaction.”

When EHRs are compared to other business software, and mobile applications they deserve a "FAIL"  Physicians have been coerced (read extorted) to acquire the obsolete software by a combination of inadequate incentives // penalties, if not used and according to a format that encourages analytics.

Standards for interoperability  are in place, however adoption remains a barrier. The Office of the National Coordinator for Health Information Technology (ONCHIT) stimulated the development of such a standard for EHR to insure interoperability between disparate EHR software.  While the standard is encouraged by incentives and penalties, adoption is slowed by lack of financial models.  

Different regions of the country use different health information exchanges and some have none. In addition, even those who have formed exchanges, there may be poor participation resulting in inadequacy.   Challenges remain, including user buy-in, lack of interest and/or need. Another challenge is the financial model for sustainability. Several different models exist.

Despite numerous usability issues, physicians are mandated to use certified EHR technology to participate in the federal government’s EHR incentive programs. Unfortunately, the very incentives intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues. The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting meaningful use standards. Moreover, federal certification criteria for EHRs need to allow vendors to better focus on the clinical needs of their physician customers.

Building on its landmark study with RAND Corp. confirming that discontent with electronic health records (EHRs) is taking a significant toll on physicians, the American Medical Association (AMA) called for solutions to EHR systems that have neglected usability as a necessary feature. Responding to the urgent physician need for better designed EHR systems, the AMA released a new framework outlining eight priorities for improving EHR usability to benefit caregivers and patients.

“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said AMA President-elect Steven J. Stack, M.D. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

“Now is the time to recognize that requiring electronic health records to be all things to all people — regulators, payers, auditors and lawyers — diminishes the ability of the technology to perform the most critical function — helping physicians care for their patients,” said Dr. Stack. “Physicians believe it is a national imperative to frame policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus.”

To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs, the AMA framework outlines the following usability priorities along with related challenges:

• Enhance Physicians’ Ability to Provide High-Quality Patient Care
• Support Team-Based Care
• Promote Care Coordination
• Offer Product Modularity and Configurable
• Reduce Cognitive Workload
• Promote Data Liquidity
• Facilitate Digital and Mobile Patient Engagement
• Expedite User Input into Product Design and Post-Implementation Feedback