Caregivers
Awareness drives health improvements
As with so many other things in life, improved awareness can make a positive change to your health.
Here’s a nice study where US barber shops installed blood pressure check machines and it was found that for men with hypertension, their conditions improved if they chose to get checked after their haircut.
Sounds trivial – but there’s an expense in the machinery which is paid back in the health outcome.
LHD hopes to harness the same effect by encouraging tracking and management of personal lifestyle and health. We are working particularly on community care situations at present…. hopefully we can give you news of a trial using community nurses soon.
Drugs, surgery and (sometimes) psychiatry. It isn’t enough!
One of the members of our Advisory Board, Dr. Stanley Pappelbaum (former CEO of Scripps hospital chain in San Diego, California) has a very succinct way of putting things.
Sometimes it can seem as though there are so many treatment paths in medicine, that it all gets overwhelming. However, as Stan says,
There are essentially just three interventions in medicine; drugs, surgery and sometimes psychiatry.
The implications of this simple statement are quite profound. Given that 75% of cost of the US Healthcare system is now due to chronic illness and disease, how much of this figure can be helped by drugs, surgery and psychiatry? By the time you need these interventions for chronic illness in a very real sense it is too late; you already have it!
This reminds me the number of 6,000+ billing codes in the US Healthcare system related to reimbursement for procedures that are given for prevention; zero!
This all gives one pause to think, doesn’t it?
Yours in Health,
Hamish
Tools to assemble all the pieces of primary care data together
This coming Thursday I give a talk to the General Practice Research Group at Otago University.
Otago University is one of the two main medical schools in New Zealand, and is highly regarded internationally for its innovative research and education of top class clinicians.
Some of the General Practitioners in the Department have expressed interest in Lifetime Health Diary™, especially as we are now beginning to be used on the ground by registered nurses in community health settings. Anything that can alleviate pressure points in healthcare delivery, particularly around early interventions and patient engagement, is something of interest to General Practice and I look forward to the opportunity to demonstrate what our product can do.
Topics I will be covering will include…
- How to improve communication between patient, community care provider & General Practitioner.
- Smoother handoffs between different care settings and providers (including better follow up and communication tool after discharge.
- Provide better and quicker understanding of poly-medication regimes.
- Medication Optimisation and measuring patient progress by regimes.
- Health Reconciliation Tool between rest homes, GPs and pharmacists.
- Distance medicine / Rural health.
- Green prescriptions (i.e. exercise and lifestyle recommendations), patient health management & patient safety.
- Preparing for the upcoming 40-year bulge of aging Baby Boomers
I look forward to writing up some notes about GP reaction, comments, and generally what happened at the talk next week.
Yours in health,
Hamish
Better hospital hand-offs for patients with multi-med regimes
Last week I wrote about Hospital hand-offs and medical errors, and how they are a systemic problem in hospitals and that it is an area that needs to be improved.
It is a complex problem, a number of organizations are embarking on projects in attempts to solve the issue. There are various innovative strategies such as Project BOOST and Project RED (Re-Engineered Discharge), which respectively provide a comprehensive toolkit for handoffs and patient-centered interactions to learn about after-care plans following discharge.
Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston writes about a Senior Resident, Kelly Graham, who helped initiate three simple interventions that dramatically improved patient handoff outcomes.
Recently I met with the CEO from Mercy Hospital in Dunedin, who said that
a better tool for medication hand-offs would help during admissions as well as patient discharges. All too often now the “Hospital Reconciliation Tool” consists simply of patients bringing a bag with all the meds they are on
- we checked with Beth Israel Medical Center in New York, where it is also the same procedure. Conversations we have had with various clinicians indicates that to hope that all medications are all neatly noted down correctly and then made available for clinicians in the hospital to view whenever required is just that, a hope.
We hope we can provide a solution to at least the medicine reconciliation part of the equation soon with our new Med Optimization tool. It should work for hospital handoffs as well as community-based healthcare at pharmacies. If anyone working at a hospital would like to try out a better handoff tool for medication regimes, by all means drop us a line.
Yours in health,
Hamish
Hospital hand-offs and medical errors
If you have ever spent time in an ICU (Intensive Care Unit), you know the story…
People lie in beds on the verge of death, with tubes stuck into their bodies at all angles, respirators forcing life-giving oxygen into their inactive lungs, loved ones holding their hands at their bedside.
What is striking is the impassiveness and professionalism of the staff going about their job, making sure that the bio-chemical reactions of their patients are kept stable as much as possible. I guess it has to be like that as a coping mechanism for the staff in order to cope that with day after day, patient after patient. If you got emotionally involved in an ICU, where so many people end up not making it, you probably would burn out in a short period of time.
The problem is that despite this admirable professionalism, the sheer volume of patient information transmitted as each shift of staff comes in to replace the next means there is lots of opportunity for mistakes to occur. Apparently, such hand-offs take place 4,000 times a day in the hospital, or 1.6 million times per year. Lots of stuff slips through the gaps. But this situation is made much worse by the fact that there is no formalized data transfer system for what is known as “patient handoffs”, where patient data and updates are passed from one clinician to another. It is ad-hoc and lacking structure to a frightening degree.
Taking into account how critical it is to have right information at the right time being transferred in an ICU precisely as is there are very few tools yet to reduce risks during the hand-off process. This area of a hospital life has been always associated with medical and medication errors during geographical transitions (from one floor or department to another), care transition (hospital admissions), staff shift rotations during the day and night and a variety of other transitions that allow for the possibility of miscommunication.
That patient hand-offs are ad-hoc, disorganized, inefficient and have to be improved has become very clear for the Joint Commission Center for Transforming Healthcare. Patient hand-offs are one of the improvement projects the Center embarked on August 2009 in order to reduce the mistakes and improve delivery of healthcare because lives are at stake especially in critical units such as ICU. Better tools are needed.
I will pick up this topic in following posts!
Government Priorities in New Zealand Healthcare for the Disabled and Disadvantaged
- Every health organisation collects patient healthcare information.
- Health results to be made available to clinicians.
- By 2014 an individually owned health record by all New Zealanders.
“Health IT is hard because it is a reflection of a culture and its beliefs”.
“Where do the 5%-10% of people with different disabilities and chronic illnesses, who actually really need improved health information management systems and who are obviously among the most costly to treat, fit in this system? Will we have to wait till 2014 or beyond until something will be available? Would it be an idea to put something out there, maybe not very pretty, but something simple, test it, get feedback from the users, improve, test again, get feedback, improve etc? We can quite quickly develop something which can change not only how the data is managed but actually positively impact the lives of many people and organisations who are supporting them, leading the way to transformation of medical industry.”
Our First Community Group Meeting! (Part 2: Question & Feedback Session)
The participants from various organizations definitely saw the idea as an innovative way forward. Some great examples were brought up on why and how such a system could contribute to creating better health outcomes, provide economical advantages and prevent mistakes and oversights, and halt a growing inequality of health care access, stress and disengagement.
It was a great learning experience to see how lack of adequate health information for those disadvantaged such as the blind, deaf, sick children, people with chronic diseases, parents and caregivers ethnical groups leads to inability to manage, monitor or even access appropriate health care. For use by the blind the tool would need integration with ‘talking data’ but it was considered to be very positive for the hearing-impaired, as a very needed communication tool with health professionals. Also some noted this would be a great tool for recording children’s health – as children`s complete information is usually only known by the parents, but when the child reaches adulthood this information can be forgotten, or not passed on etc.
Almost 40 minutes discussion among 13 participants brought up lots of issues. The main ones examined were privacy and security. Some participants made the counter point that Lifetime Health Diary can be useful for privacy issues. Additionally some commented that privacy waivers are common place. The consensus seemed to be that perfect privacy and security are an ideal that must be strived for, but that it is even more important to simply start.
One example was given where deaf people health consultations often result in shouted conversations in front of other people, whereas this kind of Diary could act as a mediation tool.
Some barriers in uptake were identified as well. Computer literacy, access to the internet, cultural readiness and acceptance were those listed by participants.
Everybody`s involvement was definitely a sign of a great need to address current problems in a fast and cost efficient manner. The bottom-up approach was seen as the way to go, as community-based solutions are needed. Although many questions were fielded, there was a huge recognition and understanding that the Diary is a positive way forward and although there are no perfect solutions to some of the issues, a start needs to be made.
Funding
The participants suggested a couple of funding opportunities including the Tindall Foundation and Working Together More Fund, the Health Innovation Fund at the ACC, The Ministry of Health and some internal programmes run by participating organisations expressed their readiness to work together.
First steps forward
First step needs to be taken! The opportunity to do so will be in a study run by a team of Ignite Consultants. From Monday 23rd of August, five highly motivated, talented and hand-picked students will start to explore how Lifetime Health Diary™ can be helpful for different community groups. Study will be concentrated on the readiness of particular communities, including examining the motivation, perception, potential barriers, as well as looking into the usability of the technology which needs to be adjusted to the specific needs of people on the ground. The team of students will be working for 8 weeks under the guidance of Alec Holt, the Director of the Health Informatics programme at Otago University as well as mentors from the not-for-profit community
We believe that by working collaboratively on enabling the most disadvantaged in our communities and their caregivers to have better access to relevant and needed health information (which they can share with their doctors and other health professionals) can truly lead not only to better health outcomes, but significantly improve the quality of lives, engage and empower people to take charge of their health.
The Project is about to start…!
Are you ready to find out what your doctor is saying about you?
I personally like the idea of a doctor sharing his notes with the patient. So many other people do. That is why a year-long OpenNote project kicked in few weeks ago to find out if this transparency can facilitate doctor-patient communication, educate individuals about their own health and improve health outcomes. The team of nurses, physicians and 25,000 patients at Beth Israel Deaconess, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle got seriously involved in the project. Peer-review evaluation by both doctor and patient is to come.
There are two sides of this “coin” being discussed. One is sharing the notes with the patients will improve their understanding of health, empower, educate and engage them more while adding transparency. Another is sharing the notes may lead to confusion and panic on the patient side. Thus, because of a specific terminology and abbreviations, individuals may take doctor’s notes in a wrong way. For example, OD does not mean overdose, but rather oculus dexter, or right eye.
It is said this system of sharing the notes will benefit those who have many medical problems and visit doctors quite frequently. It will let them be well informed about their health, ask questions and follow the medication and lifestyle regime prescribed by the doctors. Yet, I quite disagree with that. I do believe it will benefit those who do a general once-a-year check up – someone like me. If I do not understand the term I always can go online and check it, so other can.
More information on OpenNote project:
